Page 285 - Critical Care Nursing Demystified

270 CRITICAL CARE NURSING DeMYSTIFIED

other and the next phase of care will not proceed until the current prior-
ity is satisfactorily managed. The first survey is known as the primary
survey.
3. Primary survey – Five steps are involved in this process and include airway
management, breathing support, circulatory support, examining for dis-
abilities, and exposing other injuries. These are known as the ABCDE
priorities of the primary survey.
A – Airway: A continued assessment of the patient’s airway for clearance
and removal of obstructions. Head and neck stabilization must be main-
tained until cervical spine x-rays rule out spinal cord injury.

B – Breathing: A balance between oxygen supply and demand must be
ensured. Supplemental oxygen is provided to ease the efforts of breathing,
particularly if the patient has dyspnea and discomfort from chest
trauma.
C – Circulation: Circulatory status is assessed through skin color, tempera-
ture, mental status, and signs of hypothermia and hypovolemia. Cardiac
monitoring with pulse oximetry is also initiated to identify cardiac
dysrhythmias. An IV is inserted and the patient is monitored for shock. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

D – Disabilities: A mini neurological examination is completed to deter-
mine motor strength and level of consciousness (LOC). Some sources use the
AVPU method to describe levels of consciousness for its ease of memoriza-
tion. For example: A – alert, V – responds to verbal stimuli, P – responds to
painful stimuli, and U – unresponsive. A Glasgow Coma Scale is performed.
E – Exposure: The patient is undressed and each body region is examined
for additional injuries. The patient’s dignity must be maintained, and it is
also important to keep the patient warm with warming blankets if
available. Evidence for legal issues may be assessed, like bullets, drugs, or
weapons. Try not to compromise evidence.

NURSING ALERT

A rapid assessment of a traumatized patient with life-threatening conditions should
take no longer than 60 seconds to perform.

4. Secondary survey/resuscitation – A more detailed survey is conducted
and starts at the patient’s head and works down to the patient’s feet.
The patient needs to be log-rolled from side to side to inspect the