Primary Survey Secondary Procedures First Aid Chapters 4,5,6 Primary Survey Secondary Procedures First Aid

Primary vs. Secondary Assessment Primary Assessment Life-threatening Conditions Determine Responsiveness Check ABC’s Airway Breathing Circulation Secondary Assessment You have ruled out Life-Threatening conditions Begin HIT/HOPS History Inspection/Observation Palpation S/Testing (Special Testing) Life Threatening Conditions Respiratory Arrest (breathing has stopped) Cardiac arrest (heart has stopped) Internal bleeding Shock Burns Heat-related illness Cold-related Illness Asthma attack Diabetic emergency Drowning Electrocution Falls from heights Poisoning Severe bleeding Anything else that causes breathing or cardiac impairment

Primary Assessment This is the first thing that needs to be done when approaching a victim. Once a life-threatening condition has been ruled out, your evaluation can continue. Airway Partial Airway Obstruction Universal Choking Sign Total Airway Obstruction Breathing Circulation Airway: 1st priority. Victim will begin to suffer brain damage after 4-6 min w/o oxygen. After 10 min irreversible brain damage can start to occur. Open airway through head tilt-chin lift method (if no neck injury). -Partial Airway Obstruction: occurs when an object covers the air passage but does allow some air to flow in and out of the lungs. -Universal Choking Sign: grab your throat. -Total Airway Obstruction: Occurs when an object blocks the entire air passage and does not allow enough air to flow into the lungs for the athlete to take a breath. Breathing: To determine if a victim is getting air, “look, listen and feel” 5-10 sec. Look for chest to rise, Listen/feel for breath against your cheek. Circulation: Check circulation by checking pulse (carotid or radial). Check for 10 seconds to determine if a pulse is present. If pulse is present continue monitoring/rescue breathing until help arrives. No pulse—begin CPR.

SO YOUR ATHLETE IS BLEEDING… External Bleeding Ways to control it: Direct Pressure Elevation (if possible) Pressure Points Hemorrhage More severe, heavy flow of bleeding Emergency! If bleeding cannot be controlled, 911 needs to be called!!! External Bleeding: any bleeding that results from a laceration, incision, abrasion, puncture, avulsion or amputation. Hemorrhage: extremely heavy bleeding, external or internal, that can result in death if not stopped quickly.

UNIVERSAL PRECAUTIONS Used to prevent the spread of blood-borne pathogens. Barrier Protection Sharps Disposal Infectious Control Hand Washing Barrier Protection: gloves, eye protection, face mask Sharps Disposal: used sharps should be put in proper containers. One-way access so these cannot be taken out again. Infectious Control: dispose of contaminated materials in a biohazard bag Hand Washing: if you come in contact wash your hands as soon as possible

HIT/HOPS History Inspection/Observation Palpation (Special) Testing To gather information about the situation and the injury Inspection/Observation Visual examination of the body part Palpation Examination of an injured area by touch to determine the type of injury. (Special) Testing Includes MMT, ROM evaluation, neurological testing and specific evaluations MMT = Manual Muscle Testing ROM = Range of Motion

HISTORY Common Questions to Ask… What happened? How did it happen? When did it happen? Has this happened before? Where was the pain initially? Did you hear any sounds/ feel any sensations? Were you able to continue participating? How soon did it swell? Does it feel unstable? What relieves the pain? How severe is the pain? What does the pain feel like? Are you experiencing any numbness or tingling? Have you had any treatment for this yet? If so, what has been done? Have you injured this body part before? Sounds or Sensations: pop, snap, crack, slip or give Severity of Pain: Use a scale 1-10. 1 is no pain 10 is severe pain (you need to go to the ER) What does the pain feel like?....Is it sharp, dull, aching, constant, radiating, staying in one spot?

Vital Signs These are taken during a secondary procedure. It could be part of the history or the inspection. Heart Rate (pulse) Breathing Rate (respirations) Breath Sounds/Odor Blood Pressure Body Temperature Skin Color Capillary Refill Pupillary Reaction Ability to Move Response to Pain Normal Ranges Heart Rate: 60-80 bpm Respirations: 12-20 breaths per minute dyspnea = difficulty/labored breathing apnea = temporary stoppage of breathing Breath Sounds: checked using a stethoscope. Listen for anything abnormal. Breath Odor: could indicate possible poisoning, intoxication or diabetes. Blood Pressure: systolic = heart contracting; diastolic = heart relaxing. 110-120 (systolic)/65-80 (diastolic) Body Temperature: 98.6 F/36.6 C Skin color: Four to be aware of- Bright Red: heat stroke/carbon monoxide poisoning Bluish (cyanotic): poor oxygen supply Yellow: liver illness/jaundice Pale/Lack of Color: shock/lack of circulation. Capillary Refill: pinch nail bed, should return to normal color within 1 sec Pupillary Reaction: PEARL (Pupils equal and reactive to light); should constrict with light and dilate with dark. Dilated with light: poss. Poisoning, medicated, concussion, death Constrict with dark: heatstroke, poisoning Unequal: head injury Ability to move: ROM; bilaterally compare. Is there paralysis? Response to Pain: Everyone responds differently. Use the 1-10 scale

INSPECTION/OBSERVATION Inspect surroundings for clues Look for obvious deformity, swelling and discoloration Really observe the athlete Watch how they are holding the body part Watch them as they approach you Have them walk/do a motion for you and watch their reaction You can learn a lot of things about an injury just by watching an athlete when they think you are not watching them. Send them back to do something if you feel they may not really be hurt as bad as they are saying. Watch them as they do it, if they are really struggling they may really be hurt, if they seem to be doing fine they are probably faking!

PALPATION Examining an injury through touch Compare bilaterally If something feels different, then you have probably found your point of injury.

SPECIAL TESTING Range of Motion (ROM) Manual Muscle Testing (MMT) Compare Bilaterally Test all ROM at the joint Manual Muscle Testing (MMT) Grade Scale 0-5 Table 5.1 pg 46 in book Neurological Testing Can be tested through sensation or movement Every body part is linked to a specific nerve Special Testing Specific tests for the injury Ex) Lachman’s ACL test MMT Grade Scale 0 (Zero) = No muscle contraction, no control of movement 1 (Trace) = Athlete cannot contract muscle, there is a muscle contraction observable 2 (Poor) = Full ROM w/o gravity or w/ assistance 3 (Fair) = Full ROM against gravity, no resistance 3+ (Fair Plus) = Full ROM against gravity, full ROM w/ minimal resistance 4 (Good) = Full ROM against gravity and some amount of resistance from ATC 4+ (Good Plus) = Full ROM against gravity and significant amount of resistance from ATC 5 (Normal) = Full ROM against gravity and full resistance from ATC

SIGN vs. SYMPTOM Sign Symptom Something that can be measured/observed Something that the Athletic Trainer can see or test Examples: Vital Signs Sweating Breath Odor Symptom Something that cannot be measured by the caregiver. Information is something that only the athlete will know (what they feel) Examples Pain Level Nausea

WHAT IS SHOCK? A condition in which inadequate blood and oxygen are supplied to vital organs. Inadequate blood supply to these organs will result in shock (5 organs necessary for life): Brain Heart Lungs Liver Kidneys

WHY DO WE GO INTO SHOCK? Axial blood vessels dilate while appendicular blood vessels constrict. Heart Stops Significant loss of blood Blood pressure decreases because the volume has not increased = decrease in oxygen to vital organs There is no blood flow if the heart stops. Restarting the heart is the primary concern here! This reduces blood pressure, thus reducing oxygen to the organs.

RECOGNIZING SHOCK SIGNS SYMPTOMS Agitation Nausea Rapid, weak pulse Decreased BP (100mm HG or lower systolic) Cold, clammy skin Sweating Cyanosis Increasing unconsciousness Pale skin tone SYMPTOMS Nausea Dizziness Thirst Anxiety Cyanosis = blue coloration of skin

TYPES OF SHOCK Table 5.2 pg 47 in book Psychogenic Septic Neurological Cardiogenic Hemorrhagic/Hypovolemic Metabolic Respiratory Anaphylactic Psychogenic: Temporary loss of nervous function causing blood vessels to dilate (fainting) Septic: general infection causing circulatory failure Neurological: loss of control over the nervous system causing the blood vessels to dilate (spinal cord injury) Cardiogenic: heart stops (heart attack) Hemorrhagic: loss of blood (internal bleeding) Metabolic: loss of fluids via vomiting, diarrhea, or urination (diabetics) Respiratory: breathing stops. Lowers oxygen levels in blood, causes organs to shut down Anaphylactic: toxin in the system causes breathing to stop. Lowers oxygen levels of blood (asthma or bee sting)

TREATING SHOCK Treat the original injury Keep the athlete warm Elevate arms and legs 10-12in above heart (as long as there is no fracture) Measure respirations and pulse every 5min Don’t give them anything to eat or drink If vomiting occurs, put them in recovery position Get them to hospital ASAP!!

ASSESSING FRACTURES Check: Capillary refill Pulse Sensation in extremity Do not ask the athlete to use the body part as it could cause further damage!

MANAGING FRACTURES Requires immediate attention from a Physician Splint the area whether the fracture is obvious or not (if you suspect a fracture, splint it) Once the athlete is splinted, they can be moved and should be monitored for signs/symptoms of shock

TYPES OF SPLINTS Types of splints: Traction Splint Rigid Splint Semi-rigid Splint Soft Splint Traction: used when a larger bone (like the femur) has been fractured. It pulls the bone ends apart and into alignment causing muscle tissue to relax and decrease pain Rigid: stiff material applied to either the side, front or back of an extremity. Must be padded and wrapped to the limb. Semi-rigid: moldable splint that hardens in place to hold fracture. Ex) vacuum splint Soft splint: remains soft after splint is applied. Ex) pillow, slings, swaths, air splints—should be checked regularly for holes!

PRICE Protection Rest Ice Compression Elevation Method used to treat most injuries. Protection: keep body part protected from further injury Rest: allows body part to heal Ice: reduces swelling and pain. 20 minutes on, one hour off. If kept on longer than 20 min can get frostbite or vasodilatation occurs (reverse effect of what we want to happen). Ice 3-4 times a day if possible. Compression: pressure applied to prevent swelling from building. May be done with pads, ace wraps, or tape. Elevation: body part should be kept 10-12in above heart to prevent swelling from accumulating in the injured area. Should not be done if athlete happens to have a heart condition.

HEAT-RELATED PROBLEMS Hyperthermia = an exceptional rise in body temperature Heat Cramps Heat Exhaustion Heat Stroke Medical emergency, 911 needs to be called Heat Cramps: involuntary muscle contractions caused by dehydration and loss of sodium as a result of profuse sweating. Treat: drink water, stretch, ice Heat exhaustion: caused by prolonged exercise in a hot, humid environment to the point of severe dehydration Symptoms: fatigue, dizziness, nausea, headache, muscle cramps, shortness of breath and distorted vision Signs: excessive sweating, rapid weak pulse, decreased blood pressure, skin cold and pale, normal body temp Treat: cool the athlete down—remove them from hot environment (shaded area or inside if possible), fan, cold, wet towels, sip water….could progress to heat stroke if not given prompt medical attention. Heat stroke: a dangerously high core body temperature that is caused by the shut down of the hypothalamus (resulting from exercising in a hot, humid environment, severe dehydration, excessive weight loss, obesity, untreated heat exhaustion) Signs: little or no sweating, hot dry skin, body temp of 105 F or more, low blood pressure, rapid weak pulse, rapid breathing rate, dilated pupils, unconsciousness Treat: lower body temp ASAP—cold, wet towels to neck, armpits, feet, groin; elevate legs to prevent shock **death or irreversible brain damage can occur if not treated immediately!

HOW TO PREVENT HEAT-RELATED ILLNESS Acclimatize Wear lightweight uniforms Frequent water breaks Weigh in before and after practice Check humidity and temperature Avoid saunas and hot-tubs for extended time Eat properly Get plenty of rest Replace fluids lost after practice STAY HYDRATED ALWAYS!!!! Starting to drink water when you are thirsty is too late. Athletes should regularly drink about 32oz (4 8-oz cups) of water daily. When they are practicing in heat, that number should go up. Avoid drinks with a lot of sugar in them (pop, kool-aid). Humidity is the key factor, when it is humid it is damp in the air and an athlete will tend to not sweat which is the body’s natural cooling system.

COLD-RELATED PROBLEMS Hypothermia = subnormal body temperature from prolonged exposure to damp cold. Frostbite PREVENTION Dry, non-restrictive clothing Acclimatize Layers Avoid outdoors in extreme cold Cover head, mouth and extremeties Try to stay dry Wind-resistant clothing Hypothermia = at 95 F the first signs/symptoms of hypothermia occur Frostbite = exposure to cold for a long period of time. Body part will freeze (usually nose, ears, fingers, toes) -treat with gradual rewarming by placing effected body part in water heated to 102 F -when part is pink, dry it off and wrap in sterile dressings

FOR YOUR QUIZ 3 things you are looking for in a Primary Assessment Universal Precautions Sign vs. Symptom Explain HOPS 5 organs necessary to sustain life Types of shock Explain PRICE Prevention of Heat-related Illness