Primary & Secondary Survey

catastrophic injuries

• fatalities, injuries that result in permanent functional disability, serious injuries result in temporary functional disability w full recovery

• EX: spinal cord injuries, exertional sickling, rhabdomyolysis, commotio cordis

catastrophic injury outcome

• fatality

• nonfatal: permanent or sever functional disability

• serious: no permanent functional disability but severe injury

catastrophic injury classification

• traumatic (direct): resulted directly from participation in skills of sport

• exertional/medical (indirect) injury: caused by systemic failure as result of exertion while participating in sport or by competition secondary to non-fatal injury

sudden death

sudden cardiac arrest, exertional heat stroke, traumatic head injuries, sickle cell trait, lightning, spinal cord injury, internal injuries, asthma, anaphylaxis, hyponatremia, suicide

pre-event medical meeting aka medical “time out”

1. advanced cardiovascular life support (ACLS)

2. AED placement on sidelines

3. sentinel seizure/agonal respiration awareness procedures

4. backboard

5. face mask removal and tools

6. c-spine injury protocol

7. environmental risk status (heat, lightning, cold)

8. cool prior to transport

9. lightning plan

10. hermorrhage control kit

primary survey

• takes 30secs-2mins with max on-scene time being 10 mins carried out w/ little or no movement of patient

• goal to assess for existence of potentially life-threatening situations (level of consciousness, airway, breathing, circulation, severe bleeding, shock)

• cause of sudden collapse: 3 Hs head, heart, heat

• treat as you go

check > check-call-care

• scene is safe

• identify what happened

• patient for airway, breathing. circulation, fxs, bleeding

call > check-call-care

• 911

• give proper directions (EAP)

• meet ambulance

care > check-call-care

• calm and reassure patient

• reassess and monitor vitals

• control bleeding

• immobilize injured body parts

• provide CPR and first aid

Priority managment

• highest: respiratory, cardiovascular, ext severe hemorrhage

• high: shock, other hemorrhage, spinal cord injuries, sever burns

• low: lower GI tract, peripheral vascular/nerve/locomotor injuries (open or closed), facial and neck injuries, cold exposure

• special: fxs, dislocations

DR ABCDE

wash hands, approach with care

D- dangers (scene is safe)

R- responsiveness

A- airway (open and maintain)

B- breathing (look, listen, feel, measure)

C- circulation (look, listen, feel, measure)

D- disability (major signs of injury, neurological funct)

E- exposure (blood loss, deformity)

establishing unresponsiveness

A- alert (orientation to time, place, person, event)
V- verbal (unresponsive but responds when spoken to)

P- painful (responds only to painful stimuli —> pinch nail bed or rubbing sternum)

U- unresponsive (unconscious and unresponsive to verbal and physical stimuli)

in sports emergencies

5-10 secs

C- circulation: pulse (carotid if unresponsive, radial if responsive, distal pulse if Fx); if no: CPR and AED

A- airway: head-tilt-chin-lift or jaw thrust

B- breathing: assess rate and quality

S- severe bleeding: quick assessment and direct pressure

S- shock: skin color, temp, capillary refill

S- spinal injury: squeeze hands, wiggle toes

CPR

1. circulation: pulse (5-10s), 1 rescuer = 100 compression/min, multiple rescuer = 30:2, recheck pulse after 2 mins or after 5 cycles

2. airway: head tilt chin lift

3. breathing: obstruction?

automatic ext defibrillator (AED)

• device evaluates heart rhythms of victims experiencing cardiac arrest

• can deliver electrical charge to heart

• patient should not be on metal or wet surface during use

• Avive: connects AEDs as network and notifies 911 w/ coordinates

defibrillation!!

• heart: muscle so time is critical; can be due to structural reasons, acquired issues, or electrical changes

• every min delay is 10% decrease in survival

• out of hospital: 10% chance of survival

• AED: 4% decreased in survival rates for every min- hands over sternum- left breast, right collar

establishing breathing

• head tilt chin lift- deliver ventilation

• if breath does not go in, reposition and ventilate (need to create good seal)

• if airway cont to be obstructed, perform 30 chest compressions and look for object

• repeat until ventilation occurs

• if available, use bag/valve mask for respiration (prevent spread of disease)

• no breathing, patient has pulse: 1 ventilation every 5s in adult and 1 breath every 3s for child or infant

obstructed airway management

• individual cannot breathe, speak, or cough, and may become cyanotic

• stand behind patient w one fist against body and other over top just below xiphoid process

• provide forceful thrusts to abdomen (up and in) until obstruction is clear

• unconscious then check pulse and start CPR

choking

blocked airway

obstructed airway adjunct devices

• open airway and attempt to ventilate

• failure? 30 chest compressions, check

• finger sweep; be sure not to push object in further w sweep

• suction: suctioning can reduce risk of aspiration (inhale liquid) into lungs, tube should reach only base on tongue, length of tube can be est by measuring dist from corner of mouth to same side earlobe

symptoms of sudden cardiac arrest

lightheadness, dizziness, syncope (fainting), chest pain, palpitations (heart beating weird), nausea/vomiting, fatigue/weakness, shortness of breath (common)

hemorrhage

internal or external bleeding

universal precautions must be taken to reduce risk of exposure to bloodborne pathogens

• arterial: flows in spurts and bright red (extreme med emergency)

• venous: dark red w continuous flow

• capillary: exudes from tissue and reddish (least severe)

control of hemorrhage

• direct pressure: firm pressure (hand and sterile gauze) placed directly over site of injury against bone; capillary = less pressure

• elevation: reduces hydrostatic pressure and facilitates venous and lymphatic drainage- slows bleeding

• pressure points: eleven points on either side of body where direct pressure is applied to slow bleeding; push up-0chain arteries

secondary survey

• if conscious cont w secondary survey

• rapid assessment, focused assessment, vital signs, musculoskeletal eval (head to toe exam), treatment consideration —> call 911 or transport off-field/court

ambulation

• two person manual conveyance ambulatory aid

• go from prone to supine or side-lying

• then sit and wait 15-30s

• weight on uninvolved, knee bent, patient grasps ATs hands and stands up

immediate treatment

PEACE & LOVE

protection, elevation, avoid anti-inflammatories, compression, education & load, optimism, vascularization, exercise

splinting

• splint above and below suspected fx site

• air split (leg): clear plastic split inflated w air around affected part, used for splinting but required practice, do not use if it will alter fx deformity, provides mod pressure and can be xrayed

• SAM splint (wrist): thin sheet of pliable aluminum covered w padding

vital signs

• temp

• pulse

• respiratory rate

• blood pressure

• oxygen saturation

temperature

97.8-100.4F (98.6F)

pulse

60-100bpm

respiratory rate

12-18bpmb

blood pressure range

90/60-130/90mmHG

oxygen saturation

95-100%

primary survey takeaways

will they die in next few mins?

• bleeding, airway, breathing, circulation, diability

secondary survey takeaway

what exactly is wrong

• history, vitals, neruo, MSK

survey takeaways

• life before limb

• primary before secondary