Primary and Secondary Survey
Jan 17, 2016
Primary and Secondary Survey
Primary Survey
Determines level of responsiveness
Recognizes immediate life-threatening situation Airway (jaw thrust)
Breathing
Circulation (neck, same side)
Dictates actions needed for care
Primary Survey
What is Triage? Do athletic trainers need to triage injuries?
Life threatening injuries take precedence Early advanced life support is key to survival
Concerned about 3 systems Respiratory system
Circulatory system
Nervous system
Secondary Survey
Gather Specific information about injury
Assess vital signs
Perform more detailed evaluation of conditions that don’t pose life-threatening consequences Identify conditions that are serious and may need medical
attention
Primary Survey
Is the athlete’s life in immediate jeopardy? Respiratory system
Airway and Breathing
Circulatory system
Pulse
Hemorrhage
Nervous system
Responsiveness- AVPU
AVPU
Alert
Verbal
Pain
Unconsciousness
What Causes Unconsciousness?
Fainting (Syncope)
Concussion
C-spine Injury
Epilepsy
Skull Fx
Heat Illness
Diabetic Coma
Shock
Cardiac Arrhythmia
dehydration
What Causes unconsciousness?
What makes these different? Sudden Onset
Fainting, concussion, C-spine, heat stroke, heat syncope, Cardiac arrhythmia, epilepsy
Gradual Onset
Skull fx, heat exhaustion, diabetic coma, cardiac arrhythmia, dehydration, shock
Dealing with the Unconscious Athlete
Athletic Trainer must assume the athlete has a life threatening condition until proven otherwise
Note body position and level of consciousness
Check ABC’s
Assume cervical spine injury until proven otherwise
Dealing with the Unconscious Athlete
With athlete supine and not breathing Check ABC’s
If athlete is supine and breathing: Nothing should be done until consciousness resumes
Monitor vitals
Dealing with the Unconscious Athlete
If prone and not breathing Log roll and check ABC’s
If prone and breathing Nothing until consciousness resumes
OR
Carefully log roll and monitor ABC’s
How to Log Roll
1 person stabilizing head
2+ people on one side of the body
1 arm up above head
Slowly roll over
Dealing with the Unconscious Athlete
Life support should be maintained and vitals should be monitored until emergency personnel arrive
Once stabilized, a secondary survey should be performed
Life Support
ABC’s of CPR A- Airway opened
Jaw thrust
B- Breathing
Look, listen, feel
C- circulation (pulse)
Carotid artery 1st, hen look for signs of circulation
AED Automated External Defibrillator
No pulse and shockable rhythm
Hemorrhage
Arterial Bright red, flows in spurts
Venous Dark red, continuous flow
Capillary Reddish, exudes from tissue
Hemorrhage
External Bleeding CEP
Compression- hand and sterile gauze placed directly over site of injury
Elevation- reduces hydrostatic pressure and facilitates venous and lymphatic drainage- slows bleeding
Pressure Points- direct pressure applied to the brachial or femoral artery
Hemorrhage
Internal bleeding
Can occur beneath skin, intramuscularly or in jt. with little danger contusions
Bleeding within body cavity could result in life and death situation Body cavity feels ridged
Referred pain
Ex: rupture spleen- Pain in L shoulder
Difficult to detect and must be hospitalized for treatment
Could lead to shock if not treated accordingly
Vital Signs
Pulse- beats/min
Respiration
Blood pressure- systolic/diastolic
Temperature
Skin color
Pupils- PEARL
Level of consciousness
Movement
Shock
Changes in vital signs can signal shock
Occurs when there is a diminished amount of blood available to circulatory system
Shock
Generally occurs with severe bleeding, fx, or internal injuries Restless
Drowsy and sluggish
Pulse (weak or rapid)
Rapid/ shallow breathing
Decreased blood pressure (systolic below 90)
Cold/ clammy skin
Pale/ blueish skin
Sweating
Dull eyes
Thirsty
incontinence
Shock
Several types of shock Metabolic
Occurs when illness goes untreated or when extensive fluid loss occurs
Hypovolemic
Decreased blood volume resulting in poor oxygen transport
Anaphylactic
Severe allergic reaction
Respiratory
Lungs unable to supply enough oxygen to circulating blood
Cardiogenic
Inability of heart to pump enough blood
Shock
Management Maintain core body temperature
Elevate feet and legs 8-12” above heart
Positioning may need to be modified due to inury
If the face is pale, raise the tail
If the face is red, raise the head
Keep athlete calm as psychological factors could lead to or compound reaction to life threatening condition
Shock
Management Limit onlookers and spectators
Reassure the athlete
Do not give anything by mouth until instructed by physician
Secondary Survey
HOPS History
Observation
Palpation
Special Tests
Secondary Survey
Special Tests AROM
PROM
RROM
Weight bearing
Ligamentous tests
Neurological tests
Dermatomes
Myotomes
Secondary Survey
Vital Signs Pulse
Respiratory rate
Blood Pressure
Temperature
Skin color
Pupils
Level of consciousness
Secondary Survey
Musculoskeletal Assessment Treatment
Emergency Splinting
Moving and Transporting the Athlete