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KEY POINTS

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KEY POINTS

  1. The goal of the first 5 minutes of resuscitation is to establish conditions in which resuscitation can be effectively carried out, identify immediate life threats, and initiate stabilizing therapies.

  2. Cardiac arrest must be recognized immediately, and may be missed in unresponsive or intubated patients unless specifically sought.

  3. The four signs of airway embarrassment are change in voice, stridor, mishandling of secretions, and airway posturing.

  4. Point-of-care sonography is indicated early in the management of all patients.

  5. Blood pressure is the most basic proxy for tissue perfusion; however, a more reliable indicator of successful resuscitation is end-organ function.

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Resuscitation—reanimation in many languages—is the restoration of life where it is absent or diminished. Resuscitation is the simultaneous identification and treatment of threats to life, limb, or function and is initiated by any qualified person whenever and wherever such a threat is recognized.

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The need for resuscitation may announce itself with obvious signs such as a patient struggling to breathe or speak, by dramatic alterations in mental status, or by abnormal vital signs, but may also be manifested by more subtle markers of serious illness such as singed nasal hair, muffled voice, or a mottled extremity.

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We will first describe a stepwise approach to the initial phase of resuscitation of the undifferentiated, critically ill patient—the primary survey—and then more comprehensively discuss the basic assessments, maneuvers, and strategies central to any resuscitation paradigm.

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THE PRIMARY SURVEY

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The goal of the first 5 minutes of resuscitation is to establish the conditions in which resuscitation can be effectively carried out, identify the most immediate life threats, and initiate stabilizing therapies (Table 2–1). The acronym used here is DC3A-J:

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Table Graphic Jump Location
Table 2–1The primary survey.
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  • D: Danger

    The first priority in resuscitation is to determine that it is safe to approach the patient; the first D stands for Danger—danger to the provider and the treatment team. This preliminary step assumes much greater importance in the prehospital environment than the operating theater, but all patients pose a potential threat to their treating clinicians. Scene security (from fire, armed aggressors, etc) is a clear priority in the field. In all settings, appropriate personal protective equipment to shield against bloodborne or airborne infectious disease is essential. Occasional patients will have a dangerous substance on their skin or clothes and require decontamination.

    The agitated patient deserves special consideration. In addition to the potential for violence against providers, which by itself would indicate appropriate chemical and physical restraint as an early priority, agitated patients ...

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