Department of Medical Education

Ayub Medical College

MODULE # 6
Primary & Secondary Survey
Helmet Removal, Cervical Collar,
Spine Immobilization
OBJECTIVES OF THE SESSION
 Initial Assessment
 Primary Survey

 Secondary Survey

 Video Presentations

 Helmet Removal

 Cervical Collar Application

 Spine Immobilization
 FIRST AIDER -
A PERSON WHO CAN:
 PRESERVE Life

 PROTECT - the Unconscious

 PREVENT- Illness or Injury from

becoming worse

 PROMOTE - Recovery, lessen anxiety,

relieve pain

“DO NO HARM”
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
 TRAUMA VS MEDICAL PATIENTS
 Patients can generally be divided
into Two categories:
• Those who suffer from Trauma/Injury
• Those who have sudden Illness
 Change sequence when dealing with
an Illness:
• Obtain medical history before physical
examination
PERFORM INITIAL ASSESSMENT
 Form a general impression of patient
 Assess responsiveness - Patient is either
Responsive or Unresponsive
• Introduce yourself
• Ask Patient’s Name, Place and Time
• Ask for Chief Complaints
 PRIMARY SURVEY DRcABCDE
 Danger - Self, Scene & Survivor safety
 Response Shake & Shout
 catastrophic Hemorrhage - try to
immediately stop it with sustained direct
pressure or a tourniquet (if indicated)
 Airway – Make sure Airway is clear of
obstructions
• Open the airway by Head Tilt, Chin Lift
• Jaw Trust for suspected C-Spine Injury
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 PRIMARY SURVEY DRcABCDE
 Breathing – Look, listen and feel to see
if the patient is breathing normally
 Circulation - Checking the pulse rate,
skin colour, Capillary Refill time, blood
pressure
 Disability - Life threat to identify is
traumatic Brain injury
 Exposure - Remove clothing initially
and look for any other obvious life
threatening injury – Burns etc 7
 LEVEL OF CONSCIOUSNESS
AVPU Scale
 Alert: Patient will be awake, responsive,
oriented, and talking with you
 Verbal Response: Patient who appears to be
unresponsive at first, but will respond to a
loud verbal stimulus from you.
 Painful Stimuli: Patient does not respond to
verbal stimuli, s/he may respond to painful
stimuli e.g. Pressing the finger nail bed
 Unresponsive: Patient does not respond to
either painful or verbal stimuli
 Patient at P and/or U level may need proper
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Airway management
 SKIN CONDITION
 Check for Skin  Skin may be:
Color • Hot and dry
 Pale, flushed, blue, or • Hot and moist
yellow
• Cold and dry
 Moisture • Cold and moist
 Temperature
 SECONDARY SURVEY
 Performed once the patient has been
resuscitated and stabilized
 Consists of two parts:-
 Visual component is the ‘Head to
Toe’ physical assessment
 Verbal component is basic medical
questioning using the APVU Scale,
SAMPLE, OPQRST Assessment tools
 Avoid any delay in shifting the critical
patient 10
SIGNS OF INJURY - DOTS

• Deformities

• Open injuries

• Tenderness

• Swelling
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 EXAMINE HEAD AND EYES
• Examine Head: Use both hands, Do not move
patient’s head, Remove eyeglasses if
necessary
• Inspect for any Bleeding and obvious
Deformity
• Examine Eyes: Check the Eyes, (PEARRL)
• Pupils Equal And Round, Reactive to Light
• Check Ears for blood, fluid or bruising
• Check Nose for bleeding or deformity
 EXAMINE PATIENT’S NECK
• Examine each side of the Neck
• Check for Bruising, Bleeding or Deformity.
• Palpate for a Carotid pulse
• Check for pain, Neck veins
• Check for a Medical identification Tag
 EXAMINE PATIENT’S CHEST
• Inspect for equal rise & fall, paradoxical
movement, Bleeding, Bruising
• Palpate for Tenderness and Crepitus
• Check for pain on Inhalation/Exhalation
• Look for signs of difficult Breathing
• Note Injuries, Bleeding, or abnormal,
unequal, or Painful movement
• Check for collarbone or rib fractures
EXAMINE PATIENT’S ABDOMEN
• Inspect for bruising, signs of external
bleeding, distention, penetrating injuries,
or protruding parts
• Check for stomach rigidity or swelling
• Check genital area for external injuries
 EXAMINE PATIENT’S PELVIS
• Check for obvious bruising, bleeding, or
swelling, deformity
• Check for pain & palpate for tenderness
 EXAMINE PATIENT’S BACK
 Stabilize head and neck
 Inspect for bleeding, bruising,
deformity. Palpate for pain/tenderness
 EXAMINE THE EXTREMITIES
 Inspect for Bleeding, Bruising,
Tenderness, Crepitus, Deformity, range
of motion.
 Check for CSM functions
 Circulation
 Sensory
 Motor
 PAIN ASSESSMENT
 Onset – What the patient was doing when the pain
started, whether the pain has come on suddenly OR
gradually
 Provocation – Ask patient what makes it worse –
movement, palpation, positioning OR Anything that
makes it better – position, movement, rest.
Quality – Is the pain sharp, dull, crushing, stabbing,
burning; constant, intermittent or comes in waves?
Radiation – Ask patient to point with one finger
where the pain originates from and going anywhere
 Severity – Scale 0-10, with ‘0’ being no pain at all,
‘10’ being the worst possible pain.
 Timing – Ask patient how long it has been going for?
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Wong-Baker Faces Scale
for Children

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 MEDICAL HISTORY: SAMPLE
 Signs and Symptoms
 Allergies – Medicines, Food any other item
 Medications – Taken medication they’re
supposed to be taking
 Past medical history –Asthma, diabetes,
epilepsy? Recent surgery? Anxiety, depression
 Last ins and outs – What & when patient
last ate and drank. When they last went to
urinate and defecate. For females ask about
menstruation
 Events leading - to the Illness or Injury
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 PUPIL SIZE AND REACTIVITY
 P.E.A.R.R.L
 A - Remain constricted:
Often present in person
who is taking narcotics
 B - Remain dilated:
Indicate a relaxed or
unconscious state
 C - Unequal size: Can
indicate stroke or brain
injury
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 CAPILLARY REFILL
 Ability of circulatory system to return
blood to capillaries after blood is
squeezed out
 Done on patient’s fingernails or
toenails. Normal CR = <2 seconds
 Will be delayed or absent if patient:
• Has lost lot of blood
• Blood vessels to limb
are damaged
• Is very cold
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 ONGOING ASSESSMENT
 Monitor patient’s Vital Signs:
•Every 5 minutes if unstable
•Every 10 minutes if stable
 Maintain an open airway
 Monitor breathing and pulse

 Monitor skin color & temperature

SPRAINS AND STRAINS: P.R.I.C.E
 Prevent
 Rest

 Ice: Apply a cold pack

 Do not apply ice directly to skin

 Compress: Use an Elastic /
Crepe Bandage - Not too tight
 Elevate: Above heart level to
control internal bleeding
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RECOVERY POSITION

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 Videos

Hemorrhage Control
Helmet Removal
Cervical Collar
Spine board Immobilization

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Thank You