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In this video, we are going to look at the concept of the primary survey. And I can say that after 30 years of practice that I put this into practice, every time I approach a patient without fail.

The first part of the primary survey is about danger. Then we look at the response and then we follow the mnemonic CABCDE. Which is C for catastrophic bleeding, A for airway, B for breathing, C for circulation, D for dysfunction and E for expose and examine.

So taking it from the top, after we have cleared the scene for safety issues, we can approach the patient and assess for the levels of response, just by asking, "Are you okay?" Sometimes the patient will, their head will turn as you walk into a room and you know that that patient is alert then. Having established the levels of response of the patient, we can then move on to C to look for catastrophic haemorrhage.

When I say a catastrophic haemorrhage, I mean haemorrhage that will rapidly kill your patient. Most often it's visible but sometimes it can be hidden in clothing, in bedding, carpets, on surfaces like soil and gravel. It's sometimes impossible to see. But if we see bleeding at this stage we must stop it using a tourniquet or haemostatic dressing or direct pressure to arrest the haemorrhage.

We then move on to airway. If the airway is blocked or occluded the patient won't be breathing and will rapidly become hypoxic and die. So we need to use basic airway manoeuvres, suction and airway adjuncts to manage the airway.

Then we move on to B, which is breathing. Assessing the patient's respiratory rate. Are the lungs inflating and deflating as they should? The patient's SPO2 and the general colour of the patient to see for cyanosed. Between A and B, it's always worth having a look at the neck to have a look for any distended neck veins or any other things around the neck which might give you an indication of an injury or a condition in the chest.

After B, we move on to C, which is circulation and we should always check the patient's colour, the peripheral and central pulses and the blood pressure and also assess the cavities for any bleeding.

For example, are there any pulsating masses or hard lumps or any guarding in the abdomen and is there any bleeding from the penis or the vagina or the rectum. We should go on then to assess the dysfunction of the patient. So we will be looking at the pupils, the blood sugar levels and the patient's level of response using the AVPU scale.

We also do the temperature at this stage as it may give us an indication as to whether the patient is hypo or hyperthermic. And finally, we need to expose and examine the patient as relevant. We are looking for rashes, oedema, bruises, potential haemorrhage or anything that might give us an indication as to why that patient is presenting as they are. If we don't find any complications in the primary survey then we can move on to do a secondary survey. But if we do come across complications in that primary survey we must deal with them as we find them as these are the things that will kill the patient first.

And remember a primary survey can be done in just a few seconds. In a conscious patient without injuries, it may take five or 10 seconds, but it can be done quickly. And it's only when we have completed a primary survey and identified that there are no life-threatening conditions that we can then move on to further investigations.