Exam 1 Study Guide
Ch. 14, 62, 72
1. Primary survey: you must know A-G assessment and interventions
A: airway and alertness/c-spine stabilization
o Alertness assessment:
AVPU method:
A: alert
V: responds to voice
P: responds to pain
U: unresponsive
o Airway assessment:
Assess for partial or complete obstruction, we need to know whether
their airway is effective or ineffective
Assess for hypoxia, brain damage, hypercarbia, respiratory or cardiac
arrest
Assess for patency:
Vocalization
Tongue
Loose teeth or foreign objects
Bleeding
Vomitus or other secretions
Edema
Burns
Look, listen, and feel
Avoid yes/no questions to avoid head shaking
Try to get the patient to where they can see your face to decrease desire
to move their neck
o Interventions:
Stabilize c-spine; assume there is a c-spine injury until proven otherwise
Reposition the head
Heimlich/abdominal thrusts
No trauma: head-tilt-chin lif
Suspected trauma: jaw thrust-we want to avoid manipulating the c-spine
Removal of loose objects or debris
Logroll patient
Stabilize head
Suctioning: g-tube
Insertion of oral or nasal pharyngeal airway
Nasal: doesn’t initiate gag reflex
Oral: initiates gag reflex
ETT insertion/RSI protocols
B: breathing and ventilation
, o Assessment:
LOC
Spontaneous respirations
Rate, depth, pattern: too fast, slow, or not present
Symmetric chest rise and fall
Presence and quality of bilateral breath sounds
Color
Presence of indicators of work of breathing:
Nasal flaring
Retractions
Head bobbing
Expiratory grunting
Accessory muscle use
JVD
Tracheal position
A tension pneumothorax is indicated and very serious
Chest wall integrity
Sucking chest wound: open wound to chest that has caused a
lung to collapse and the patient is breathing through the nose
but is also getting oxygen in the chest through the wound,
causing increased intrathoracic pressure
o Interventions:
Tension pneumothorax:
Oxygen administration: 15L/min with non-rebreather
Prepare to assist with needle thoracentesis if tension
pneumothorax is present:
i. 14 gauge needle is inserted into chest to release the
pressure built up in the collapsed lung that is putting
pressure on the other lung
Apply 4x4 dressing and wound and tape it on 3 sides because if
all 4 sides are taped there is no way for the oxygen to escape
from the chest and decrease the intrathoracic pressure
You can also use an impregnated/Vaseline dressing on the
wound instead of a 4x4 gauze
C: circulation and control of hemorrhage
o Assessment:
Reduction in circulating blood volume: primary cause of shock
Quick radial and peripheral pulse assessment: rate and quality
Skin color
Capillary refill
Uncontrolled bleeding
Shock s/sp**
Muffled heart tones
Main sign of pericardial tamponade
, o Interventions:
Pericardial needle aspiration: used for pericardial tamponade
Control external bleeding
Obtain vascular access: as we start IVs, draw blood samples as well
Consider I/O insertion
Administer IVFs
20mL/kg of crystalloids (NS/LR)
Repeat bolus if needed
Consider blood transfusion
10 mL/kg
Obtain labs
Initiate cardiac compressions if HR is <60/min in kids
D: disability-neuro status
o Assessment:
Brief neuro assessment
Interpret findings based on age and developmental level
Glasgow coma score (GCS)
AVPU
Pupils
o Interventions:
Conduct further investigation during 2nd survey
Initiate drug therapy:
Mannitol: cerebral swelling
Consider intubation: if not able to maintain airway because of neuro
reasons
Glucose?
E: expose/environmental control
o Remove clothing:
Save for forensics
Safety:
Don’t stick your hands in their pockets
Don’t cut through forensics
Watch for glass and other things that may be in the bed
o Keep patient warm:
Warm blankets
Warm IVFs
Overhead lights
Temp of room
F: full set of vitals and family presence
o Vitals:
Temp, pulse, respirations, BP
o Family: family is allowed to be present because if something goes wrong, it
helps with acceptance/closure later on for them to see you doing everything you
can to help save their loved one
Ch. 14, 62, 72
1. Primary survey: you must know A-G assessment and interventions
A: airway and alertness/c-spine stabilization
o Alertness assessment:
AVPU method:
A: alert
V: responds to voice
P: responds to pain
U: unresponsive
o Airway assessment:
Assess for partial or complete obstruction, we need to know whether
their airway is effective or ineffective
Assess for hypoxia, brain damage, hypercarbia, respiratory or cardiac
arrest
Assess for patency:
Vocalization
Tongue
Loose teeth or foreign objects
Bleeding
Vomitus or other secretions
Edema
Burns
Look, listen, and feel
Avoid yes/no questions to avoid head shaking
Try to get the patient to where they can see your face to decrease desire
to move their neck
o Interventions:
Stabilize c-spine; assume there is a c-spine injury until proven otherwise
Reposition the head
Heimlich/abdominal thrusts
No trauma: head-tilt-chin lif
Suspected trauma: jaw thrust-we want to avoid manipulating the c-spine
Removal of loose objects or debris
Logroll patient
Stabilize head
Suctioning: g-tube
Insertion of oral or nasal pharyngeal airway
Nasal: doesn’t initiate gag reflex
Oral: initiates gag reflex
ETT insertion/RSI protocols
B: breathing and ventilation
, o Assessment:
LOC
Spontaneous respirations
Rate, depth, pattern: too fast, slow, or not present
Symmetric chest rise and fall
Presence and quality of bilateral breath sounds
Color
Presence of indicators of work of breathing:
Nasal flaring
Retractions
Head bobbing
Expiratory grunting
Accessory muscle use
JVD
Tracheal position
A tension pneumothorax is indicated and very serious
Chest wall integrity
Sucking chest wound: open wound to chest that has caused a
lung to collapse and the patient is breathing through the nose
but is also getting oxygen in the chest through the wound,
causing increased intrathoracic pressure
o Interventions:
Tension pneumothorax:
Oxygen administration: 15L/min with non-rebreather
Prepare to assist with needle thoracentesis if tension
pneumothorax is present:
i. 14 gauge needle is inserted into chest to release the
pressure built up in the collapsed lung that is putting
pressure on the other lung
Apply 4x4 dressing and wound and tape it on 3 sides because if
all 4 sides are taped there is no way for the oxygen to escape
from the chest and decrease the intrathoracic pressure
You can also use an impregnated/Vaseline dressing on the
wound instead of a 4x4 gauze
C: circulation and control of hemorrhage
o Assessment:
Reduction in circulating blood volume: primary cause of shock
Quick radial and peripheral pulse assessment: rate and quality
Skin color
Capillary refill
Uncontrolled bleeding
Shock s/sp**
Muffled heart tones
Main sign of pericardial tamponade
, o Interventions:
Pericardial needle aspiration: used for pericardial tamponade
Control external bleeding
Obtain vascular access: as we start IVs, draw blood samples as well
Consider I/O insertion
Administer IVFs
20mL/kg of crystalloids (NS/LR)
Repeat bolus if needed
Consider blood transfusion
10 mL/kg
Obtain labs
Initiate cardiac compressions if HR is <60/min in kids
D: disability-neuro status
o Assessment:
Brief neuro assessment
Interpret findings based on age and developmental level
Glasgow coma score (GCS)
AVPU
Pupils
o Interventions:
Conduct further investigation during 2nd survey
Initiate drug therapy:
Mannitol: cerebral swelling
Consider intubation: if not able to maintain airway because of neuro
reasons
Glucose?
E: expose/environmental control
o Remove clothing:
Save for forensics
Safety:
Don’t stick your hands in their pockets
Don’t cut through forensics
Watch for glass and other things that may be in the bed
o Keep patient warm:
Warm blankets
Warm IVFs
Overhead lights
Temp of room
F: full set of vitals and family presence
o Vitals:
Temp, pulse, respirations, BP
o Family: family is allowed to be present because if something goes wrong, it
helps with acceptance/closure later on for them to see you doing everything you
can to help save their loved one
