Secondary (2°) survey

Question of the day What is the goal of the 1º survey and what are some of the problems that should be ruled out?

ANSWER 1º survey= identify life threatening or potentially life threatening problems Examples include loss of consciousness, airway/breathing compromise, circulatory compromise, severe bleeding, shock.

2° Survey non-life threatening more detailed 2 main types HOPS SOAP

HOPS History Observation Palpation Strength/Special tests

History (Hx) Most important part of exam Questions Mechanism of injury (MOI)? Where is pain? How much pain? Type of pain? Acute vs. Chronic? Better or worse? Sounds and sensations (pop, crack, etc.) Numbness and tingling? Current tx? By end of Hx, you should have DDx http://www.canberra.edu.au/__data/assets/image/0009/686070/questions.jpg

Observation Can be done simultaneously with hx Look for deformity (obvious), swelling, discoloration ROM http://fnc0486.files.wordpress.com/2009/09/searching-man.jpg

Observation Observe contributory factors (i.e. knee alignment, shoulder position, gait, etc.) DON’T JUST TX EFFECT, TX THE CAUSE!!! Use information to rule out/confirm DDx

Palpation Temperature Bony anatomy Soft tissue (muscles, ligaments) Crepitus, “clicking,” “popping” Use information to rule out/confirm DDX

Strength Testing/Special Tests Manual Muscle Testing (MMT) Identify which muscles are injured or are over/under active Special Tests all depends on hx, observation, and palpation By end of this, should have Dx and tx plan

SOAP Subjective Objective Assessment Plan First half is HOPS Second half is more detailed

Subjective Same as “History” Subjective- non-measurable What should we have by the end of this?

Objective Measurable Includes Observation, Palpation, Strength, and Special Tests Objective measures are all used to confirm/rule out DDx

Assessment Assessment=diagnosis Called assessment for two reasons initially, AT not allowed to dx assessment can be more detailed Ex 1 (diagnosis): 2° ankle sprain Ex 2 (assessment): athlete presents with decreased ROM, moderate pain, moderate ligamentous laxity, and inability to perform activities of daily living

Plan Tx Modalities Rehab Referral Return to play progression

Sideline 2° survey Less thorough but should still have a good idea of nature of injury Identify whether it is safe for athlete to return to play by ruling out significant injury Time is of the essence!! http://files.stv.tv/img/articles/167230-long-term-injury-blow-for-hibernians-zemmama-410x230.jpg

Conclusions 2° survey is much more detailed non-life threatening injuries can use HOPS or SOAP (need HOPS for SOAP) Treat __________ not _____________? Determine a pattern (doesn’t have to be in perfect order) so it becomes second nature easy to remember less likely to miss components eliminates unnecessary movements for athlete