1. Primary and Secondary Survey

3. Primary Survey  Determines level of responsiveness  Recognizes immediate life-threatening situation  Airway (jaw thrust)  Breathing  Circulation (neck, same side)  Dictates actions needed for care

4. Primary Survey  What is Triage?  Do athletic trainers need to triage injuries?  Life threatening injuries take precedence  Early advanced life support is key to survival  Concerned about 3 systems  Respiratory system  Circulatory system  Nervous system

5. Secondary Survey  Gather Specific information about injury  Assess vital signs  Perform more detailed evaluation of conditions that don’t pose life-threatening consequences  Identify conditions that are serious and may need medical attention

6. Primary Survey  Is the athlete’s life in immediate jeopardy?  Respiratory system  Airway and Breathing  Circulatory system  Pulse  Hemorrhage  Nervous system  Responsiveness- AVPU

7. AVPU  Alert  Verbal  Pain  Unconsciousness

9. What Causes Unconsciousness?  Fainting (Syncope)  Concussion  C-spine Injury  Epilepsy  Skull Fx  Heat Illness  Diabetic Coma  Shock  Cardiac Arrhythmia  dehydration

10. What Causes unconsciousness?  What makes these different?  Sudden Onset  Fainting, concussion, C-spine, heat stroke, heat syncope, Cardiac arrhythmia, epilepsy  Gradual Onset  Skull fx, heat exhaustion, diabetic coma, cardiac arrhythmia, dehydration, shock

11. Dealing with the Unconscious Athlete  Athletic Trainer must assume the athlete has a life threatening condition until proven otherwise  Note body position and level of consciousness  Check ABC’s  Assume cervical spine injury until proven otherwise

12. Dealing with the Unconscious Athlete  With athlete supine and not breathing  Check ABC’s  If athlete is supine and breathing:  Nothing should be done until consciousness resumes  Monitor vitals

13. Dealing with the Unconscious Athlete  If prone and not breathing  Log roll and check ABC’s  If prone and breathing  Nothing until consciousness resumes OR  Carefully log roll and monitor ABC’s

14. How to Log Roll  1 person stabilizing head  2+ people on one side of the body  1 arm up above head  Slowly roll over

15. Dealing with the Unconscious Athlete  Life support should be maintained and vitals should be monitored until emergency personnel arrive  Once stabilized, a secondary survey should be performed

16. Life Support  ABC’s of CPR  A- Airway opened  Jaw thrust  B- Breathing  Look, listen, feel  C- circulation (pulse)  Carotid artery 1 st, hen look for signs of circulation  AED  Automated External Defibrillator  No pulse and shockable rhythm

17. Hemorrhage  Arterial  Bright red, flows in spurts  Venous  Dark red, continuous flow  Capillary  Reddish, exudes from tissue

18. Hemorrhage  External Bleeding  CEP  Compression- hand and sterile gauze placed directly over site of injury  Elevation- reduces hydrostatic pressure and facilitates venous and lymphatic drainage- slows bleeding  Pressure Points- direct pressure applied to the brachial or femoral artery

19. Hemorrhage  Internal bleeding  Can occur beneath skin, intramuscularly or in jt. with little danger  contusions  Bleeding within body cavity could result in life and death situation  Body cavity feels ridged  Referred pain  Ex: rupture spleen- Pain in L shoulder  Difficult to detect and must be hospitalized for treatment  Could lead to shock if not treated accordingly

20. Vital Signs  Pulse- beats/min  Respiration  Blood pressure- systolic/diastolic  Temperature  Skin color  Pupils- PEARL  Level of consciousness  Movement

21. Shock  Changes in vital signs can signal shock  Occurs when there is a diminished amount of blood available to circulatory system

22. Shock  Generally occurs with severe bleeding, fx, or internal injuries  Restless  Drowsy and sluggish  Pulse (weak or rapid)  Rapid/ shallow breathing  Decreased blood pressure (systolic below 90)  Cold/ clammy skin  Pale/ blueish skin  Sweating  Dull eyes  Thirsty  incontinence

23. Shock  Several types of shock  Metabolic  Occurs when illness goes untreated or when extensive fluid loss occurs  Hypovolemic  Decreased blood volume resulting in poor oxygen transport  Anaphylactic  Severe allergic reaction  Respiratory  Lungs unable to supply enough oxygen to circulating blood  Cardiogenic  Inability of heart to pump enough blood

24. Shock  Management  Maintain core body temperature  Elevate feet and legs 8-12” above heart  Positioning may need to be modified due to inury  If the face is pale, raise the tail  If the face is red, raise the head  Keep athlete calm as psychological factors could lead to or compound reaction to life threatening condition

25. Shock  Management  Limit onlookers and spectators  Reassure the athlete  Do not give anything by mouth until instructed by physician

26. Secondary Survey  HOPS  History  Observation  Palpation  Special Tests

27. Secondary Survey  Special Tests  AROM  PROM  RROM  Weight bearing  Ligamentous tests  Neurological tests  Dermatomes  Myotomes

28. Secondary Survey  Vital Signs  Pulse  Respiratory rate  Blood Pressure  Temperature  Skin color  Pupils  Level of consciousness

29. Secondary Survey  Musculoskeletal Assessment  Treatment  Emergency Splinting  Moving and Transporting the Athlete