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