Primary Secondary Survey

1
Primary / Secondary Survey

• James Maison, MS, ATC, CSCS
• January 16, 2004

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Primary Survey

• The systematic assessment of life threatening
  conditions.
• Life threatening conditions are defined as the
  following
• Obstructed airway
• No breathing
• No circulation
• Profuse bleeding
• Shock
• No other steps should be taken until this has
  been completed.

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Primary Survey

• Remembering your
• A
• B
• Cs
• Helps

Responsiveness Airway Breathing Circulation Hemorr
hage
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Primary Survey

• Responsiveness
• Conscious / Unconscious / Transient
• Airway
• Open or Closed (foreign object/anatomical block)
• Breathing
• Presence-
• Look for the chest to rise and fall?
• Feel for breaths against your own cheek
• Circulation
• Presence- Carotid artery (adults, children),
  Brachial artery (infants)

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Primary Survey

• Responsiveness
• Unconscious with suspected neck injury
• Shout and clap in front of the persons face
• Unconscious without neck involvement
• Tap the victim on the shoulder and ask What
  happened, are you okay?
• Transient
• Indication of a possible concussion or seizure
• Airway
• Neck involvement Jaw Thrust
• No Neck involvement Head tilt-Chin lift

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Primary Survey

• Breathing
• Get down close to the victim and Look, Listen,
  and Feel
• Circulation
• Feel for a pulse in the Carotid Artery
• Just inferior to the angle of the jaw
• Check for at least 10 seconds

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Primary Survey

• Hemorrhage (Bleeding)
• External
• Arterial rapid, bright red, rhythmic spurts
• Care apply direct pressure with to major
  arteries proximal to injury
• Venous steady flow, dark red
• Care apply direct pressure with a sterile
  bandage / gauze pad directly to site of injury

8
Primary Survey

• Hemorrhage
• Internal
• gtgtSigns and Symptoms
• Bruised, swollen, tender or rigid abdomen
• Bruises on chest or ribs
• Blood in vomit
• Wounds that have penetrated the chest or abdomen
• Bleeding from rectum, vagina, or penis
• Fractured Pelvis
• Abnormal pulse
• Difficulty breathing
• Cold, pale, moist skin

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Primary Survey

• Shock
• acute peripheral circulatory failure due to
  depression or collapse of the CV system
• Signs and Symptoms
• Rapid, weak pulse
• Cool, clammy skin
• Rapid, shallow breathing
• Pale skin with cyanotic mucus membranes
• Nausea, possible vomiting
• Dull, lackluster eyes, dilated pupils
• Steadily Falling BP
• Unconsciousness

10
Primary Survey

• First Aid for Shock
• Control Bleeding
• Maintain Body temp (cover with a blanket)
• Properly position athlete
• Feel elevated (if neck injury is not suspected)
• Supine
• Side-lying position (use if athlete begins to
  vomit)
• Semi-reclined (for difficulty breathing)
• Monitor vital signs
• Administer oxygen if available
• Loosen tight fitting clothing
• Administer NOTHING by mouth (NO WATER)
• Do not show athlete the injury (Hysteria can
  worsen Shock)
• Reassure the athlete

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Primary Survey

• Once the Primary Survey has been completed,
  appropriate steps should be taken to care for the
  Victim.
• E.g. Call 911, CPR, Rescue Breathing, Abdominal
  Thrusts (Heimlich maneuver), Maintain Airway.
• Once the victims status has been stabilized or
  regains consciousness, the Secondary Survey
  should be conducted
• If the victims vital sign have not been
  stabilized before advanced care arrives, continue
  emergency procedures until they do.

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Secondary Survey

• This is a full body evaluation for other,
  non-life threatening conditions in order to gain
  more information about the victims injuries.
• The Survey will vary slightly between the
  conscious and unconscious victim.
• Most times in sports, the secondary survey can be
  done all at once by looking at the athlete and
  noticing anything out of the ordinary, however,
  the following explanations are important to look
  over and understand what is abnormal.

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Secondary Survey

• Unconscious Victim
• Pulse Rate
• Respiration Rate
• Head to Toe Evaluation
• Deformity
• Skin Color
• Skin Temperature
• Pupils
• Blood Pressure
• Fluid Discharge
• Pain Reaction

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Secondary Survey

• Conscious Victim
• Level of Consciousness
• Injury history
• Sensory Function
• Motor Function
• Pulse Rate
• Respiration Rate
• Head to Toe Evaluation

• Deformity
• Skin Color
• Skin Temperature
• Pupils
• Blood Pressure
• Fluid Discharge
• Pain Reaction

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Secondary Survey

• Pulse Rate
• Normal adults 60-80 bpm
• Athletes may have a slightly lower resting heart
  rate due to training effects on the body
• Alterations
• Rapid / slow
• Weak / strong
• Irregular

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Secondary Survey

• Respiration Rate
• Normal adult 12-16 breaths/min
• Children 20-25 breaths/min
• Athletes may have a slightly lower respiration
  rate due to training effects on the body
• Alterations
• Rapid / shallow
• labored / gasping / wheezing / gurgling
• Visit www.rale.ca for Example Breath sounds
• No breath sounds

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Secondary Survey

• Head to Toe Evaluation
• Basic Principles
• Comprehensively observe and palpate the body
• Check for Medic Alert tags
• Watch the patients facial expression while
  palpating
• Listen to patients voice, if conscious, while
  palpating

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Secondary Survey

• Head to Toe Evaluation
• Specific areas of investigation
• 1. Obvious deformity
• Compare body parts bilaterally, checking for
  symmetry among bones and muscles.
• E.g. obvious fracture or tendon rupture

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Secondary Survey

• Skin Color
• A good indicator of the victims state of health
• Light-skinned Athletes
• Red
• Heat Stroke
• High Blood Pressure
• White
• Shock
• Heat Exhaustion
• Internal Bleeding

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Secondary Survey

• Skin Color (continued)
• Blue
• Airway Obstruction
• Heart Dysfunction
• Respiratory Dysfunction
• Dark-skinned athletes
• Look at the coloration of the
• Nail-bed
• Lips
• Mouth
• Tongue
• A grayish / cyanotic color indicates Shock

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Secondary Survey

• Skin Temperature
• Hot dry
• Heat stroke
• Cool clammy
• Shock
• Heat exhaustion
• Cool dry
• Hypothermia

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Secondary Survey

• Eye / Pupil Evaluation
• Symmetry
• Discoloration
• Jaundice
• Hyphema
• Coordination of movement
• Nystagmus- uncontrolled sticking or shaking
• Pupil Reaction
• Should be equal reactive
• Dilated
• Head injury, shock, heatstroke, hemorrhage
• Under the influence of a stimulant drug
• Constricted
• Under the influence of a depressant drug

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Secondary Survey

• Blood Pressure
• Systolic pressure (top number)
• Normal range of males 15-20 y/o 115-120 mmHg
• Diastolic pressure (bottom number)
• Normal range of males 15-20 y/o 75-80
• Normal BP range for females is 8-10 mmHg below
  the male values. Ie 110/70
• High values BP over 135 / 85
• Low values BP over 110 / 60

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Secondary Survey

• Fluid Discharge
• Cerebrospinal Fluid (CSF)
• Check for clear liquid originating from eyes,
  ears, nose, or scalp.
• This is a Sign of head Injury
• Blood
• Observe the extent of obvious bleeding
• Check pulse distal to wound (radial, posterior
  tibial, dorsalis pedis)
• Masked bleeding may become evident through
  palpation

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Secondary Survey
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Secondary Survey

• Pain Reaction / Motor Response
• Numbness/tingling indicates nerve or cold damage.
• Severe pain, Loss of sensation, Lack of pulse in
  a limb can be caused by the blocking of a main
  artery.
• Complete lack of pain awareness to a serious
  injury can be caused by
• Shock, hysteria, drug usage, or spinal cord
  injury.

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Secondary Survey

• Injury History / Subjective Questioning
• Any question that may give you more insight to
  the mechanism of the injury
• Only ask open-ended, non-leading questions (No
  yes/no questions)
• Major Principles
• Allow the athlete to describe what happened in
  his/her own words
• Listen attentively
• Clarify information
• Remain Calm and Reassuring

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Secondary Survey

• Examples of Subjective Questions
• Whats your chief complaint? / What hurts?
• What are you feeling? Describe your pain.
• Do you or your family have a history of any
  serious medical conditions?
• How did it happen?
• Did you or do you now hear or feel any Rice
  Krispie sounds?
• Was there any deformity present, did it reduce
  spontaneously, or with help?
• Was there immediate or delayed disability?