Primary and Secondary Survey

1. Primary and Secondary Survey

3. Primary Survey • Determines level of responsiveness • Recognizes immediate life-threatening situation • Airway (jaw thrust) • Breathing • Circulation (neck, same side) • Dictates actions needed for care

4. 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

5. 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

6. Primary Survey • Is the athlete’s life in immediate jeopardy? • Respiratory system • Airway and Breathing • Circulatory system • Pulse • Hemorrhage • Nervous system • Responsiveness- AVPU

7. AVPU • Alert • Verbal • Pain • Unconsciousness

9. What Causes Unconsciousness? • Fainting (Syncope) • Concussion • C-spine Injury • Epilepsy • Skull Fx • Heat Illness • Diabetic Coma • Shock • Cardiac Arrhythmia • dehydration

10. 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

11. 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

12. 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

13. 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

14. How to Log Roll • 1 person stabilizing head • 2+ people on one side of the body • 1 arm up above head • Slowly roll over

15. 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

16. 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

17. Hemorrhage • Arterial • Bright red, flows in spurts • Venous • Dark red, continuous flow • Capillary • Reddish, exudes from tissue

18. 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

19. 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

20. Vital Signs • Pulse- beats/min • Respiration • Blood pressure- systolic/diastolic • Temperature • Skin color • Pupils- PEARL • Level of consciousness • Movement

21. Shock • Changes in vital signs can signal shock • Occurs when there is a diminished amount of blood available to circulatory system

22. 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

23. 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

24. 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

25. Shock • Management • Limit onlookers and spectators • Reassure the athlete • Do not give anything by mouth until instructed by physician

26. Secondary Survey • HOPS • History • Observation • Palpation • Special Tests

27. Secondary Survey • Special Tests • AROM • PROM • RROM • Weight bearing • Ligamentous tests • Neurological tests • Dermatomes • Myotomes

28. Secondary Survey • Vital Signs • Pulse • Respiratory rate • Blood Pressure • Temperature • Skin color • Pupils • Level of consciousness

29. Secondary Survey • Musculoskeletal Assessment • Treatment • Emergency Splinting • Moving and Transporting the Athlete