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PRIMARY SURVEY

&
SECONDARY SURVEY

PRESENTOR : SHELLAZIANNE ANAK


RINGAM
DATE : 20 NOVEMBER 2015
1 ) PRIMARY SURVEY
It is a quick initial assessment that been
designed to help the EMERGENCY
MEDICAL TEAM detect all immediate
threats to life.
Always assume all major trauma patients

have an injured spine and maintain spinal


immobilisation until spine is cleared.
In addition, its also a quick way for us to find

out if someone has any injuries or conditions


which are life threatening ( A T O M F C )
and deal with it in order of priority.
A : AIRWAY OBSTRUCTION

T : TENSION PNEUMOTHORAX

O : OPEN CHEST WOUND

M : MASSIVE HEAMOTHORAX

F : FLAIL CHEST

C : CARDIAC TAMPONADE
IMPORTANT COMPONENTS IN
PRIMARY SURVEY
1) General impression of the patient :

help us to decide the seriousness of the patients condition.
2) Assess the patients mental status :
o determine if the patient is responsive or unresponsive.
o clasify the patient by AVPU scale.
o A ( ALERT ) - Patient will be awake, responsive, oriented and
talking with us.
o V ( VERBAL ) - Patient who appears to be unresponsive at
first, but will respond to a loud verbal stimulus from us. The
patient may speak, groun, grunt, or simply look at us.
o P ( PAINFUL ) If theres no respond to verbal stimuli, patient
may respond to painful stimuli such a sternal ( breastbone ) rub
or a gentle pinch to the shoulder.
o U ( UNRESPONSIVE ) Patient does not respond to any
stimuli.
3) Remember the steps of DR ABCD.
o D ( DANGER ) : make sure that everyone are in safe
condition ( you, victim & any bystanders ).
o R ( RESPONSIVENESS ) : tap the victim shoulder and
ask him / her loudly sir/madam, are you okay? Ifs
theres no respond from the victim, try to find out what
is wrong with him / her. Shout for help and get someone
to call for ambulance ( 999 ). Look for no breathing or
only gasping almost simultaneously before activating
the response system. Put him / her in supine position
and initiate CPR.
o A ( AIRWAY ) : make sure that patients airway always
open and not obstruct ( FB / Floppy tongue ). Open the
airway by using 2 technique which are Head Tilt Chin
Lift ( not suspected spine injury ) and Jaw Thrust
( patient suspected with spine injury ).
oB ( BREATHING ) : Assess the patients
breathing by Look ( chest movement ), Listen
( quality of breath sounds ) and Feel ( the
presence of exhaled air ).
C ( CIRCULATION ) : check the pulse

whether absent or presence ( carotid, radial,


bracial, femoral, dorsalis pedis ). A weak
pulse may also represent a shock situation.
Provide chest compression ( 30 : 2 ). Do not
forget to find out if there is serious bleeding (
artery @ venous ). Controlled the bleeding
because it can caused shock if we detect it
too late.
D ( DISABILITY ) : can be assess by the
mental status ( A V P U ).
SECONDARY SURVEY
A focused history and physical
examinations should be performed after
the initial assessment because the main
purpose is to discover and care for the
patients specific injuries or any medical
problems.
It is assumed that the life threatening
problems have been found and corrected.
IMPORTANT COMPONENTS IN
SECONDARY SURVEY
1) Patients history :
asked the patients what actually happened leading

up to him/her injuries. Ask those around them too to


get more informations relating to the current
complaint or condition and do not forget to make a
documentation about it.
Acronym to obtain a patients history :

i. S ( SIGN / SYMPTOMS )
ii. A ( ALLERGIES )

iii. M ( MEDICATIONS )

iv. P ( PAST MEDICAL HISTORY )

v. L ( LAST ORAL INTAKE )

vi. E ( EVENTS LEADING UP TO THE ILLNESS

OR INJURY )
2) Rapid assessment : quick assessment
especially for a critical patient. Head to
toe examinations :
Head & neck : check if theres any

bleeding,swelling, sensitivity or any


deformity.
Ear : try to talk to the patient. See if

theres any respond or not. At the


same time, check if there is any blood
or clear fluid coming out from the ear.
Eyes : see wether the ayes open or

not. check the size of the pupils.


Nose : check if theres any blood in the
nostrils.
Mouth : check the patients mouth if

theres any foreign body or floppy


tongue which could block their airway.
Do not forget to look for the mouth
injuries or burns in their mouth.
Chest ; check if the chest rise easily and

evenly on each side as they breath. Feel


the ribcage to check for any deformity
or sensitivity. Note if breathing difficult
or painful in any way.
Arms & fingers : check if the patient have
any unusual feeling in their arms or fingers.
If patients fingertips are pale or greyish-
blue, this could suggest that the blood isnt
circulating properly. Also look for needle
marks on the forearms, which suggest drug
use. At the same time, do not forget to check
if they have a medical warning bracelet.
Spine : if the patient lost any movement or

sensation in their legs or arms, dont move


him/her to check the spine as he/she may
have spine injury.
Abdomen : check for any signs of
internal bleeding, distended, painful
or rigid.
Pelvic : check for incontinance urine or

feces.
Legs : try to find out any

bleeding,sweeling and deformities.


Toes : check the movements and

sensation of the toes. Compare both


feet and note if theres any abnormal
finding detected.
3) Focussed assessment : conducted on
stable patient. It focuses on a specific
injury or medical complaint.
4) Vital signs : Pulse(rate, rhytym and
strength). Respiration(rate, depth, sound
and ease of breathing). Skin signs(colour,
temperature). Pupils( size, reactions to
light, equality).
FURTHER INVESTIGATIONS
i. Blood ix : FBC, PT / APTT, VBG,
RP, ABG.
ii. ECG.
iii. X-ray : chest x-ray, pelvic x ray,
extremities x-ray
iv. CT scan
v. Ultra sound
MANAGEMENT
i. Tagging the patient at the wright
zone according to his/her condition.
ii. Monitoring the vital sign as well to
detect any abnormalities and try to
stabilize it.
iii. Serve medications as prescribe by
doctor.
iv. Admit patient to the ward.
SUMMARY
primary and secondary survey is a
key to find out and also identify life
threatening injuries.
once life threatening injury is
discovered, intervention should not
be delayed.
We also need to determined the
patients condition as well.
Rescuer palpates lower extremity.

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THANK YOU