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