chapter 20 primary and secondary survey. objectives explain the difference between primary and...
Post on 17-Dec-2015
253 Views
Preview:
TRANSCRIPT
Chapter 20Chapter 20Primary and Secondary Survey
ObjectivesObjectives Explain the difference between primary and secondary
assessment. Explain the difference between signs and symptoms. Explain the ABCs of a life-threatening emergency. Define the procedure used to restart breathing once it
has stopped. Explain the types of illnesses or injuries that cause
breathing and the heart to stop. Explain when cardiopulmonary resuscitation is used. Explain how external bleeding is controlled. Explain what precautions can be taken to prevent
communicable diseases. Ask the basic questions for obtaining the history of an
injury or illness. List the common vital signs and explain how they help
identify an injury or illness. Determine whether an injury can cause shock. Describe the procedures that the athletic trainer uses
when testing an athlete’s injury.
Emergency Procedures and Emergency Procedures and AssessmentAssessment
1. Introduction2. Permission to
treat3. Document
refusal4. Questions5. Observe for
signs/symptoms
Sign vs. SymptomSign vs. Symptom
Sign: a sense, like sweating, temperature, blood pressure, breathing rate, etc. can be observed by ATC
Symptom: cannot be seen, smelled, or heard such as nausea, headache, anxiety
Primary AssessmentPrimary Assessment
AirwayBreathingCirculation
◦Deals with life threatening injuries
Steps of primary assessmentSteps of primary assessmentCheck responsiveness by tapping or
shaking (do not jolt neck)Check Airway
◦Make sure it is openCheck BreathingCheck Circulation (pulse)Check for severe bleeding
ResponsivenessResponsivenessGently tap, do not shake!May not respond verballySpeak positively, may be able to hear
w/out being able to respond
AirwayAirway
One hand on forehead, two fingers of other hand under chin
BreathingBreathing
Look-for chest to rise and fall
Listen- for breath sounds
Feel-for breath on cheek (10 seconds)
TAKE YOUR TIME
CirculationCirculation
Take pulse◦Carotid artery◦Next to Adam’s
apple in the groove towards the side of the neck
◦Check for at least 10 seconds
What would you do???What would you do???
You are a spectator at a soccer game. The temperature is cool. A parent who is videotaping the game is pale and sweating. The man’s wife, who knows that you are a student assistant, asks you to take a look at her husband. You check his pulse. It’s so rapid you cannot count that fast. The man insists there is nothing wrong with him. The athletic trainer is on the sideline, watching the game.
Breathing EmergenciesBreathing EmergenciesCan involve any part of the respiratory
systemCan cause deathExamples
◦Ruptured diaphragm◦Punctured lung◦Anaphylaxis◦Asthma◦Airway obstruction
Breathing emergenciesBreathing emergenciesAs little as 4 minutes without oxygen can
cause permanent brain damageIf person has immediate proper care,
survival rate is 98%Significantly reduced if care is delayed by
4 minutes after breathing has stopped
Mouth-to-mouthMouth-to-mouthAKA-rescue breathingEach breath lasts 1 second1 breath every 5 seconds (after initial 2)
◦ Watch for chest to fall after giving breath◦ Use barrier device
Obstructed airwayObstructed airway Tongue is #1
obstructer
Others: food, gum, mouth guards, broken teeth, blood, vomit, & chewing tobacco.
If conscious, most will grab throat
Obstruction can be partial or total
Partial Airway ObstructionPartial Airway Obstruction
Ask athlete if they can speak, cough, or breathe
If they can, it is partial… allow them to try to expel the object them self
Total Airway obstructionTotal Airway obstructionAirway completely blocked, unable to
breathe, speak, or coughMay experience high-pitched whistling
noise from throat
What would you do?What would you do?
In the cafeteria a student tells a joke and another begins to cough forcefully just after laughing. The student continues to cough, her face is turning red, and tears are rolling down her cheeks. The athletes next to you say, “She is choking. Do something!”
Other breathing emergenciesOther breathing emergencies
Asthma◦Medication
Punctured lung Call EMS
Cardiopulmonary Cardiopulmonary EmergenciesEmergencies
Heart Attack◦Heart muscle is
damaged by : blockage of a vessel
to the heart A clot Stress over a period
of time Injury to the heart
muscle itself
Signs of a heart attackSigns of a heart attackBreathing difficultyShortness of breathBreathing faster than normalHigh, low, or irregular pulse ratePale or blue skinProfuse sweatingVomiting Sudden unexplained fainting (syncope)Elevated blood pressure
Symptoms of a heart attackSymptoms of a heart attackNauseaPersistent chest pain or discomfortAnxietyGeneral feeling of weaknesslightheadednessPersistent chest pain, not relieved by
position changes
Heart attack (myocardial Heart attack (myocardial infarction)infarction)
Angina pectoris: crushing chest pain felt by a person suffering from a heart attack
Best treatment: early recognition
Cardiac ArrestCardiac ArrestOccurs when the heart is damaged by
blockage of a vessel to the heartImmediate CPR crucial life of the victimAutomated external defibrillator (AED)
should be used if available
Hemorrhage and external Hemorrhage and external bleedingbleeding
Hemorrhage: A discharge of blood, internal or external, can cause death
External Bleeding: usually caused by a laceration, incision, amputation, avulsion, puncture, or abrasion
Control of BleedingControl of BleedingApply direct pressureElevate the body partApply a pressure bandageApply pressure to a pressure point if other
methods unsuccessful
Communicable Disease Communicable Disease TransmissionTransmissionCan be transmitted
directly or indirection by contact with an infected person
Do not allow athletes to share water bottles or towels
Universal precautionsUniversal precautions1. Wash hands after any and all contact with
an injured athlete2. User rubber gloves to create a barrier3. Clean tables, counters, etc. with a
disinfectant (1:10 bleach and water)4. Use biohazard bags for saturated
materials5. Dispose of needles or syringes in a sharps
container
Other precautionsOther precautions
Do not allow players to dip cups into a water cooler
Athletes should avoid sharing food, utensils, or drinking glasses
Athletes should avoid sharing personal items: combs, towels, clothes, etc.
Athletes should shower after each practice
Secondary AssessmentSecondary Assessment
Completed after primary assessment for non-life threatening injuries
HIT/HOPSHIT/HOPS History –first step
in determining facts
Questions- ◦ What happened? ◦ When? ◦ Previous injury? ◦ Where was the pain
initially? ◦ Did you hear or feel
a pop, snap, crack, slip, or give?
◦ Were you able to continue to participate?
◦ Medication?◦ How soon did it
swell?◦ Does it feel
unstable?
Vital SignsVital Signs Heart rate
◦ Pulse points – Carotid artery, Radial artery
◦ Pulse rate –normal for teens 60-80 beats per minute (bpm), athletes can be as low as 40 bpm
Abnormal vitalsAbnormal vitals
◦ Other abnormalities can be from medication, internal injuries, or heart abnormalities
◦ Rapid pulse- shock, hyperventilation medication, anxiety, or physical activity
Vital SignsVital SignsBreathing rate
◦Normal- 12-20 breaths/min
◦Dyspnea-difficulty breathing-common w/asthma, allergies, colds
◦Apnea-temporary stopping of breathing-may indicate head injury
Blood PressureBlood PressureBlood pressure –the
pressure exerted by the blood on the walls of the blood vessels.
Systolic pressure –heart contracting
Diastolic pressure –heart is relaxed
Pulse pressure-the difference between the diastolic and systolic
Blood pressureBlood pressure
Normal 110mm Hg systolic, and 65-80 mm Hg diastolic
Increases -head injury, activity,medication, or illness
Decreases-heart failure, hemorrhage, shock, medications, or illness
Vital SignsVital Signs
Body temperature – 98.6◦Rises-infection,
heat stroke◦Drop-shock, cold
exposure
Vital signsVital signs
Skin color ◦Bright red- heat
stroke or carbon monoxide poisoning
◦Bluish- poor oxygen supply
◦Yellow-liver illness◦Pale-shock or lack of
circulation
Vital signsVital signs
Capillary refill –check for circulation to fingers/toes◦Should not take
more than 2 seconds to return to normal
◦Abnormality can indicate fx or blood clot
Vital SignsVital Signs
Pupil Response◦Constrict –get
smaller◦Dilate –get larger◦Unequal –suspect
head injury◦Constrict in
darkness = heat stroke or poisoning
Ability to moveAbility to move
Paralysis – injury to brain or spinal cord
Hemiplegia –inability to move one side of body, indicates head injury of opposite side
Paraplegia –inability to move legs
Quadriplegia –inability to move arms and legs
Pain responsePain response
cannot be used to determine severity of injury
Inspection/ObservationInspection/ObservationObserve
surroundingsObserve the
athlete◦Limping◦Bleeding◦Swelling◦Redness
Testing/Palpation & StressTesting/Palpation & Stress
Palpation –touch
◦ Depression◦ Fluid leakage◦ Bumps◦ Crepitus◦ Asymmetry◦ Watch athlete’s
face
testingtesting
Listening to the heart – establish heartbeat, take heart rate
Range of motion testing (ROM)◦Test joints above
and below◦Active and passive◦Compare to
opposite side
TestingTesting
Strength testing ◦Manual Muscle
Testing (MMT)◦Always compare
both sides
Grading scale of strength testingGrading scale of strength testing
◦Zero to Normal grading Zero (0)-inability to move or even twitch Trace (1)-can perform a twitch Poor (2)-full ROM with gravity eliminated Fair (3)-full ROM, against gravity, no resistance Good (4)-full ROM, against gravity, some
resistance Normal (5)-full ROM, against gravity, full
resistance
Neurological testingNeurological testing
Testing to rule out neurological problems ◦Inability to feel or
move a part◦Can determine
spinal nerves involved
ShockShock
Recognizing shock◦Shock is the body’s
way of protecting the vital organs (heart, brain, lungs, liver, and kidneys)
◦Blood flow increases to these organs and away from the rest of the body
3 reasons for Shock3 reasons for Shock
Enlargement of the system ◦Imbalance of blood supply due to blood vessels
of head, chest, and abdomen enlarging and extremities constricting. Blood pressure then decreases due to lack of blood volume, therefore oxygen to vital organs is reduced.
◦Heart failure ◦Vessel failure (loss of blood)
Shock can cause DEATH
Shock S&SShock S&SSigns of shock
◦ Agitation, rapid weak pulse, decreased blood pressure, cold clammy skin, sweating, pale, cyanosis, increasing unconsciousness
Symptoms◦ Nausea, thirst, anxiety, and dizziness
Treating shockTreating shock
◦Treat original injury◦Keep athlete warm◦Elevate arms and legs if not broken◦Measure breathing and pulse every 5 minutes◦No food or drink◦If vomiting, turn on side and clear airway◦Take athlete to hospital◦Head/Neck injury-backboard, send to hospital
Assessing and managing a Assessing and managing a fracturefracture
Check capillary refill
Pulse rate of extremity
Sensation◦ Lack of pulse or
sensation may indicate serious nerve or vessel damage. Immediate referral necessary
Types of splints Types of splints
Traction splints –femur fx
Rigid splints –box, board, aluminum
Semirigid splints –moldable, vacuum◦ Moving after splinting
keep athlete comfortable, no bouncing
PRICEPRICE Protection-from further injury
Rest –for healing Ice -20 minutes, 1
hour between, 3x/day max
◦ CABN-cold, aching, burning, numbness
Compression –prevent excess swelling
Elevation-10-12 inches above heart
No HARMNo HARMDuring the first
48-72 hours◦No Heat◦No Alcohol (causes
swelling)◦No Running◦No Massage
(increases swelling)
ScenariosScenarios A 14-year-old athlete, who has an
obviously broken leg, refuses treatment. The athletic trainer cannot find a
stethoscope to use during a blood pressure test. What would you recommend?
An athlete who is in shock with an unsplinted fracture begins to vomit.
An athlete has a fracture. When the athletic trainer begins to splint the site, she discovers the air splint has a leak. There are no other splints.
top related