Chapter 20

1. Chapter 20 Primary and Secondary Survey

2. Explain the difference between primary and secondary assessment. • Explain the difference between signs and symptoms. • Explain the ABCs of a life-threatening emergency. • Define the procedure used to restart breathing once it has stopped. • Explain the types of illnesses or injuries that cause breathing and the heart to stop. • Explain when cardiopulmonary resuscitation is used. • Explain how external bleeding is controlled. • Explain what precautions can be taken to prevent communicable diseases. • Ask the basic questions for obtaining the history of an injury or illness. • List the common vital signs and explain how they help identify an injury or illness. • Determine whether an injury can cause shock. • Describe the procedures that the athletic trainer uses when testing an athlete’s injury. Objectives

3. Emergency Procedures and Assessment • Introduction • Permission to treat • Document refusal • Questions • Observe for signs/symptoms

4. Sign: a sense, like sweating, temperature, blood pressure, breathing rate, etc. can be observed by ATC • Symptom: cannot be seen, smelled, or heard such as nausea, headache, anxiety Sign vs. Symptom

5. Primary Assessment • Airway • Breathing • Circulation • Deals with life threatening injuries

6. Check responsiveness by tapping or shaking (do not jolt neck) • Check Airway • Make sure it is open • Check Breathing • Check Circulation (pulse) • Check for severe bleeding Steps of primary assessment

7. Gently tap, do not shake! • May not respond verbally • Speak positively, may be able to hear w/out being able to respond Responsiveness

8. Airway • One hand on forehead, two fingers of other hand under chin

9. Breathing • Look-for chest to rise and fall • Listen- for breath sounds • Feel-for breath on cheek (10 seconds) • TAKE YOUR TIME

10. Circulation • Take pulse • Carotid artery • Next to Adam’s apple in the groove towards the side of the neck • Check for at least 10 seconds

11. You are a spectator at a soccer game. The temperature is cool. A parent who is videotaping the game is pale and sweating. The man’s wife, who knows that you are a student assistant, asks you to take a look at her husband. You check his pulse. It’s so rapid you cannot count that fast. The man insists there is nothing wrong with him. The athletic trainer is on the sideline, watching the game. What would you do???

12. Can involve any part of the respiratory system • Can cause death • Examples • Ruptured diaphragm • Punctured lung • Anaphylaxis • Asthma • Airway obstruction Breathing Emergencies

13. As little as 4 minutes without oxygen can cause permanent brain damage • If person has immediate proper care, survival rate is 98% • Significantly reduced if care is delayed by 4 minutes after breathing has stopped Breathing emergencies

14. Mouth-to-mouth • AKA-rescue breathing • Each breath lasts 1 second • 1 breath every 5 seconds (after initial 2) • Watch for chest to fall after giving breath • Use barrier device

15. Obstructed airway • Tongue is #1 obstructer • Others: food, gum, mouth guards, broken teeth, blood, vomit, & chewing tobacco. • If conscious, most will grab throat • Obstruction can be partial or total

16. Ask athlete if they can speak, cough, or breathe • If they can, it is partial… allow them to try to expel the object them self Partial Airway Obstruction

17. Airway completely blocked, unable to breathe, speak, or cough • May experience high-pitched whistling noise from throat Total Airway obstruction

18. In the cafeteria a student tells a joke and another begins to cough forcefully just after laughing. The student continues to cough, her face is turning red, and tears are rolling down her cheeks. The athletes next to you say, “She is choking. Do something!” What would you do?

19. Asthma • Medication • Punctured lung • Call EMS Other breathing emergencies

20. Cardiopulmonary Emergencies • Heart Attack • Heart muscle is damaged by : • blockage of a vessel to the heart • A clot • Stress over a period of time • Injury to the heart muscle itself

21. Breathing difficulty • Shortness of breath • Breathing faster than normal • High, low, or irregular pulse rate • Pale or blue skin • Profuse sweating • Vomiting • Sudden unexplained fainting (syncope) • Elevated blood pressure Signs of a heart attack

22. Nausea • Persistent chest pain or discomfort • Anxiety • General feeling of weakness • lightheadedness • Persistent chest pain, not relieved by position changes Symptoms of a heart attack

23. Heart attack (myocardial infarction) • Angina pectoris: crushing chest pain felt by a person suffering from a heart attack • Best treatment: early recognition

24. Occurs when the heart is damaged by blockage of a vessel to the heart • Immediate CPR crucial life of the victim • Automated external defibrillator (AED) should be used if available Cardiac Arrest

25. Hemorrhage: A discharge of blood, internal or external, can cause death • External Bleeding: usually caused by a laceration, incision, amputation, avulsion, puncture, or abrasion Hemorrhage and external bleeding

26. Apply direct pressure • Elevate the body part • Apply a pressure bandage • Apply pressure to a pressure point if other methods unsuccessful Control of Bleeding

27. Communicable Disease Transmission • Can be transmitted directly or indirection by contact with an infected person • Do not allow athletes to share water bottles or towels

28. Wash hands after any and all contact with an injured athlete • User rubber gloves to create a barrier • Clean tables, counters, etc. with a disinfectant (1:10 bleach and water) • Use biohazard bags for saturated materials • Dispose of needles or syringes in a sharps container Universal precautions

29. Do not allow players to dip cups into a water cooler • Athletes should avoid sharing food, utensils, or drinking glasses • Athletes should avoid sharing personal items: combs, towels, clothes, etc. • Athletes should shower after each practice Other precautions

30. Secondary Assessment • Completed after primary assessment for non-life threatening injuries

31. HIT/HOPS • History –first step in determining facts • Questions- • What happened? • When? • Previous injury? • Where was the pain initially? • Did you hear or feel a pop, snap, crack, slip, or give? • Were you able to continue to participate? • Medication? • How soon did it swell? • Does it feel unstable?

32. Vital Signs • Heart rate • Pulse points – Carotid artery, Radial artery • Pulse rate –normal for teens 60-80 beats per minute (bpm), athletes can be as low as 40 bpm

33. Abnormal vitals • Other abnormalities can be from medication, internal injuries, or heart abnormalities • Rapid pulse- shock, hyperventilation medication, anxiety, or physical activity

34. Vital Signs • Breathing rate • Normal- 12-20 breaths/min • Dyspnea-difficulty breathing-common w/asthma, allergies, colds • Apnea-temporary stopping of breathing-may indicate head injury

35. Blood Pressure • Blood pressure –the pressure exerted by the blood on the walls of the blood vessels. • Systolic pressure –heart contracting • Diastolic pressure –heart is relaxed • Pulse pressure-the difference between the diastolic and systolic

36. Blood pressure • Normal 110mm Hg systolic, and 65-80 mm Hg diastolic • Increases -head injury, activity, medication, or illness • Decreases-heart failure, hemorrhage, shock, medications, or illness

38. Vital Signs • Body temperature – 98.6 • Rises-infection, heat stroke • Drop-shock, cold exposure

39. Vital signs • Skin color • Bright red- heat stroke or carbon monoxide poisoning • Bluish- poor oxygen supply • Yellow-liver illness • Pale-shock or lack of circulation

40. Vital signs • Capillary refill –check for circulation to fingers/toes • Should not take more than 2 seconds to return to normal • Abnormality can indicate fx or blood clot

41. Vital Signs • Pupil Response • Constrict –get smaller • Dilate –get larger • Unequal –suspect head injury • Constrict in darkness = heat stroke or poisoning

42. Ability to move • Paralysis – injury to brain or spinal cord • Hemiplegia –inability to move one side of body, indicates head injury of opposite side • Paraplegia –inability to move legs • Quadriplegia –inability to move arms and legs

43. Pain response • cannot be used to determine severity of injury

44. Inspection/Observation • Observe surroundings • Observe the athlete • Limping • Bleeding • Swelling • Redness

45. Testing/Palpation & Stress • Palpation –touch • Depression • Fluid leakage • Bumps • Crepitus • Asymmetry • Watch athlete’s face

46. testing • Listening to the heart – establish heartbeat, take heart rate • Range of motion testing (ROM) • Test joints above and below • Active and passive • Compare to opposite side

47. Testing • Strength testing • Manual Muscle Testing (MMT) • Always compare both sides

48. Zero to Normal grading • Zero (0)-inability to move or even twitch • Trace (1)-can perform a twitch • Poor (2)-full ROM with gravity eliminated • Fair (3)-full ROM, against gravity, no resistance • Good (4)-full ROM, against gravity, some resistance • Normal (5)-full ROM, against gravity, full resistance Grading scale of strength testing

49. Neurological testing • Testing to rule out neurological problems • Inability to feel or move a part • Can determine spinal nerves involved

50. Shock • Recognizing shock • Shock is the body’s way of protecting the vital organs (heart, brain, lungs, liver, and kidneys) • Blood flow increases to these organs and away from the rest of the body