Tunnelvision

[FranEMTnurse, CNA, LPN, EMT-I]

Have you heard of it? I was an EMT for 18 years, and every time during clinical practice, when doing to primary survey especially, we were constantantly warned against it.

PRIMARY SURVEY

The meaning is; Not getting past your basics; Treat A first.....anything that has to do with establishing a way for the patient to breathe

Then B.....Anything that has to do with breathing including profuse bleeding if you find lets say a severed artery, especially the major ones. If the patient bleeds out from a severed major artery, like the carotid, there is no way that patient is going to be able to breathe unless the major bleed is stopped first.

And finally C.......Anything that has to do with circulation. Does the patient have a pulse? If so, what type. For instance is it a rapid thready one which indicates shock.

Does the patient have head to toe pulses.

Are there any major fractures like an open compound of the femur. If so, do you know how to treat it.

Finally, check for wounds and bleeding on the rear side of the body. The reason for this is because the patient just may have an abdominal wound with bowel evisceration. If the patient is turned in B... all the bowels will fall out.

Then after the patient is stabilized enough, you can do the SECONDARY SURVEY. If not, you can perform it while on the way to the hospital. If anything gets missed, they will find it in the ER. They are trained to do that.

The main objective is to avoid tunnel vision by keeping your mind on A B C, during the primary survey.

[TopazLover, BSN, RN]

Great reminder to keep first things first and then go on. I appreciate the jog to the ole brain.

[EricJRN, MSN, RN]

Definitely, Fran. It's easy to happen. I was in a large, academic ER recently when we received a pt who was intubated for respiratory failure. We immediately noticed a funny rhythm on the monitor as EMS wheeled the patient in. There were runs of several sinus beats alternating with runs of several PVC's.

Although there were a dozen or so people in the room, at first none of us noticed something that should have been part of the primary. The patient had a tidal wave of secretions sloshing up and down her ET tube. After suctioning, the ectopy went away and we were left looking at the most beautiful sinus rhythm you've ever seen.

Sometimes it's easy to become distracted by the technology and the gruesome injuries, but we can't forget the ABC's!