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

2. 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

3. 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.

4. 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.

5. 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

6. 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

7. 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 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?

8. 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: bpm
Respirations: 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 (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

9. 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!

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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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)

17. 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!!

18. 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!

19. 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

20. 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!

21. 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.

22. 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!

23. 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.

24. 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

25. 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