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Simple secondary survey study sheet

Note to on-line users not in my classes: this is a study sheet. It is not complete instruction in first aid. In a formal class you will learn steps for recognizing emergencies, how and when to call 911, protecting yourself, (including how to obtain consent and prevent disease transmission), how to prioritize care and much more. You would always deal with life-threatening situations before you start a simple secondary survey (also known as a secondary assessment).

Students in HLTH57E (CPR) should be familiar with the material down to the section on the names of arteries.

Students in HLTH57A (first aid) and PE 28A (lifeguard training) or an enhanced staff first aid class should be familiar with everything.

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Rule #1 Don't make things worse

-don't aggravate injuries-(don't move anything you think might be broken)

-don't move victim (especially if you suspect a spinal injury) unless you absolutely must

-don't increase danger to victim

-don't expose others to risk and create more victims

-don't force first aid on a conscious, sane, sober adult who doesn't want it (get consent/explain what you are doing and keep getting consent/explaining as you go along)

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Times to suspect a spinal injury: (and use a jaw thrust instead of a head tilt, chin lift).

involved in a motor vehicle, motorized cycle, or bicycle crash as an occupant or pedestrian

trauma that results in partial or complete paralysis, numbness, tingling

a fall on land from a height greater than the victim's height (or some sources say: a fall of greater than ten feet onto head or legs, or injury as a result of a fall greater than standing height)

a seemingly minor injury might actually be a spinal injury if the victim: appears frail or is older than 65 years of age, is not fully alert, or appears to be intoxicated

a person holding his or her neck and/or head and/or complaining of weakness, pain, tingling or burning sensation in the extremities

cracked or broken helmet (bicycle, motorcycle, football, surfer's, ski, industrial hard hat)

excessive flexion, as in when the chin is forced to the chest

fall on buttocks that transfers force to spine

severe blunt force to head or trunk (hit by car)

injury that penetrates head or trunk (gunshot)

has a head or neck injury

stabbing or impalement near the spinal column

thrown from a motor vehicle or horse (as many as 75% of passenger vehicle occupants totally ejected in a crash die)

incident involving a lightning strike or near strike

injury by rockfall or avalanche

broken windshield or deformed steering wheel

not wearing a seatbelt

impact with other passengers not seatbelted

deployed airbag and no seatbelt

lap style seatbelt only

infant or child in in front passenger seat and deployed airbag

small driver and deployed airbag

infant or child found with shoulder seatbelt around neck

poorly adjusted or absent headrest in a rear-end collision

snowmobile or motorcycle under rope or wire

motorcycle accident with rider ejected or crushed between the bike and another vehicle

closed vehicle rollover

closed vehicle crash with death of another occupant

pedestrian hit by a vehicle who rolls onto the hood of the vehicle, and often hits the ground head first

hanging

found under collapsed building material or heavy debris (after and earthquake or...)

skiing or sledding into a fixed object (like a tree) or other sudden and violent deceleration

tumbling downhill without skis releasing (excessive extension or rotation)

spear tackling in football (using the head)

unconscious in water 5 feet deep or less

any injury caused by an entry, especially head first, into shallow water

diving mishap or entering water from a height, involving a diving board, water slide, enbankment, cliff or tower

diving onto an floating or submerged object/person/sandbar (at the water surface or underwater)

striking the water with a high impact (falling while water skiing or surfing, or impact with water on an imperfect dive from a great height)

hit by a boat, personal watercraft, skier, surfer, ski, or surfboard

receiving a blow to the head, including colliding with another swimmer or when plunging head-frist into a breaking wave or shallow water

any trauma situation where the victim stays unconscious or you have any doubt

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Reasons why a person might become unconscious or semi-conscious

(AEIOU TIPS)

Alcohol or other substance abuse or misuse

Epilepsy

Insulin (diabetes, high or low blood sugar)

Overdose

Underdose

Trauma, especially head injury

Infection

Psychological/Poisoning

Stroke

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Altered mental status (and possibly a confused or combatative state) can be caused by:

any of AEIOUTIPS above

fever

electrolyte imbalance (hyponatremia)

any condition that results in less blood flow to the brain

conditions resulting from mental, emotional or behavioral disorders

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SUDDEN Altered mental status, (and possibly a confused or combatative state) AKA delirium, which can indicate a life-threatening condition,

can be caused by the above. Note that this can be relatively common in elderly people and might seem like dementia, but is not.

infections including urinary tract infections, a wound, pneumonia

cancer spreading to the brain and causing hallucinations

a stroke

head injury with intracranial bleeding

severe burns

use of or withdrawal from alcohol/drugs

poisoning from lead, mercury, carbon monoxide, pesticides

chronic lung disease

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Note that heatsroke or diabetes can seem like a acutely intoxicated person.

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causes of fainting

fright, stress or excitement

tight clothing at neck

carbon monoxide poisoning

dehydration, especially severe dehydration brought on by diarrhea, vomiting or sweating, especially if the victim has not been drinking enough fluids

slow gastrointestinal bleeding with or without pain

blood volume changes (stood up too fast after prolonged sitting or lying down (more likely for pregnant,elderly), after a large meal (especially with alcohol))

diarrhea

inflamation of inner or middle ear

liquor

panic disorders and hyperventilation

dysrhythmia causing a fast heartbeat

a very slow heartrate

standing too long, especially in the heat

benign hyperventilation: an anxious person (fear of heights, animals, etc.) hyperventilates (breathes rapidly and deeply) which causes dizziness, a sensation of choking, tingling in hands & feet, chest pain &/or tightness, blurred vision and more. These symptoms being close to those of a heart attack or other serious problem can cause more concern and more hyperventilation sometimes leading to fainting. (No, do not have them breathe into a paper bag.)

some medications for high blood pressure or heart disease

recent arrival at high altitude

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arteries:

Arm = brachial

Neck = carotid

Groin = femoral

Wrist = radial

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Students in HLTH57E (CPR) should be familiar with everything above this part.

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Students in HLTH57A (first aid) and PE 28A (lifeguard training) or an enhanced staff first aid class should be familiar with everything.

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causes of seizures

lack of oxygen

stroke

epilepsy

brain tumor / concussion / increasing intracranial pressure from swelling or internal bleeding in the brain

diabetic emergency / hypoglycemia

heat stroke

failure to use prescribed anti-seizure medications

trauma

drug or alcohol use or withdrawl

measles, mumps and other childhood diseases

eclampsia (pregnancy complication)

child with a high fever

child with aspirin poisoning

infection

hit by lightning

high altitude can cause brain swelling

continuing stress from bereavement, divorce, abuse, money/family worries, critical incident stress

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Signs and symptoms of a concussion:

(Symptoms of a concussion may be delayed. They can take several hours or even days to present themselves.)

(Many teams require that an athlete with concussion symptoms be evaluiated by a medical staff member with experience in the evaluation of concussions and prohibits them from returning to play on the day of the activity. Mild symptoms can resolve themselves in less than two days, but the victim still needs to seen by a doctor.)

Appears dazed or stunned

Moves clumsily

Answers questions slowly

Loses consciousness (even briefly)

Shows behavior or personality changes / mood changes like feeling sad, anxious or listless or becoming easily irritated or angry for little or no reason. Might resist treatment.

Mental status deteriorates - sometimes moving from disoriented, to irritable, to combatative to a coma.

another source says: feeling sluggish, feeling unusally irritable

Can't recall events prior to hit or fall and/or after hit or fall

Headache or 'pressure' in head

Nausea or vomiting

Balance problems or dizziness

Double or blurry/fuzzy vision

Sensitivity to light and/or noise

Hearing problems, ringing in ears

Feeling dinged or dazed, sluggish, hazy, foggy, or groggy

Concentration or memory problems

Confusion

Does not 'feel right'

In later stages pupils may become unequal

Athlete who is confused about assignment or position, forgets sports plays, is unsure of game, score, or opponent

An elderly person can have a concussion from a seemingly minor fall. Sometimes their symptoms are mistaken for a stroke. You might not witness the fall of an elderly person, for example, but after the fact would notice some of the symptoms above and/or:

low-grade headache that won't go away

having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks or making decisions or solving problems

slowness in speaking, acting, thinking or reading

getting lost or easily confused

changes in sleep patterns, inability to wake up from sleep

sensitive to light or noise

doesn't recognise people or places

repeated vomiting

seizures (arms and legs jerk uncontrollably)

weak arms or legs, unsteady on feet

slurred speech

Note that confusion in an elderly person that comes on suddenly could be caused by a head injury OR by a medication / improperly taking a medication, OR by pneumonia/infection (sometimes without a fever or coughing).

An infant can't answer questions or tell you they have symptoms, but you might notice they cry persistantly and it is difficult to console them, are not interested in toys they usual are fond of (or might not even reach for a toy offered them), have changes in eating/drinking/nursing.

They might not interact normally with a parent/sibling, give eye contact.

They might not pay their usual attention the their surroundings. Their eyes might not follow a person/object near them, or they could even have a blank or trance-like stare.

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Treatment for closed soft tissue injuries

(RICE)

Rest to allow clots to form. Do not move or straighten the area

Immobilization

Cold: apply plastic bag of ice (with a thin barrier between the ice and skin) 20 minutes on, 20 minutes off

Elevate above heart level unless it causes more pain

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Signs of wound infection

(Older adults are at higher risk for wound infection.)

pain does not get better a few days after the injury

increasing pain, swelling or tenderness

small pimple over the wound

swelling beyond what might be considered normal for that wound

pus (with or without odor) coming from the wound (varies from white to pink or light green)

redness spreading from around the edges of the wound, progressing to red streaks extending from the wound up a limb

warmth

advanced: chills and fever, swollen glands in the groin, armpit or neck

(Especially watch punctures for early signs of infection.)

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To care for a victim of stroke, think FAST.

Face - weakness on one side of the face

Arm - weakness or numbness in one arm

Speech - slurred speech or trouble speaking

Time - Time to summon EMS personnel (call 911) if any of the above are seen and note the time the signs and symptoms began

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Normal respiration for an adult is 12 to 20 breaths per minute, children ranges with age, from pre-teens at 12 or 15 to 20 to newborns to about six weeks at 30 to 50

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Normal pulse

Adult 60 to 100

Child 80 to 150

newborn to about six weeks, 100-160

infant 80 to 120 to possibly 150

an athlete may have a pulse of 50 beats per minute or lower

Normal capillary refill is 2 seconds (not effective on very cold fingers)

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normal body temperature taken at the mouth is 98.6°F (within a range of 97°F to 99°F )

normal rectal temperature is 99.6°F

normal armpit (axillary) temp is 97.6°F

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Levels of consciousness

Person, place, time, event (their name is the last thing of these they'll remember). A person who is oriented to their surroundings and situation should be able to tell you their name, where they are, what time it is (not to the exact hour but at least if it is morning or evening, what month and year it is) and what happened to them.

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AVPU

Alert: able to respond appropriately to questions (including person, place, time and event)

Verbal: Responds appropriately to verbal stimuli when you speak or shout

Painful: Only responds to painful stimuli, such as a pinch

Unresponsive: Does not respond; no gag or cough reflex

a response could include grimacing, rolling away from your voice, moaning

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Your palm (or another source says palm and fingers) is approximately 1% of your body surface, use this to estimate extent of burns

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Sierra Club wilderness first aid "rule of fours" you can live 4 minutes without oxygen, 4 hours without shelter, 4 days without water, 4 weeks without food (but that may be the limit of any reasonable expectation of survival)

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--see pages 14-16 in American Red Cross First Aid/CPR/AED participant's manual OR 216 (skill sheet on page 239) in Lifeguarding--

Simple secondary survey , (also known as a secondary assessment) used after the initial assessment after you have ruled out or taken care of any life-threatening conditions. You might or might not have already called 911.

(Remember, don't have them move any body part you suspect is injured and if you suspect a spinal injury you would be manually protecting the spine/neck from movement and would not want them to tilt their head yes or no in the process of answering questions.)

If you did not do so already, introduce yourself, ask permission to give care, get victim's name. (At any point while you are taking this brief history or during the head-to-toe exam, if you find something that requires emergency medical personnel, stop the survey to call 911 immediately, then continue the survey.)

Interview victim (write notes, including negative answers) and give the information to EMS personnel when they arrive.

use SAMPLE as an easy way to remember the questions

Signs and symptoms

What happened to you?

Do you feel pain anywhere?

Do you feel any numbness, tingling or loss of sensation? (If yes, where?)

Are you experiencing any lightheadedness, nausea?

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Sometimes ask for details about pain:

OPQRST

Onset (What were you doing when it started hurting? Resting or active? What made it start hurting? Was it severe at first or did it get this bad over time?)

Provokes (What makes it worse/better? Does it only happen after you eat? Does it only hurt when you breathe deeply?)

Quality Ask them to describe the pain. (Is it a sharp pain, stabbing, cramping, aching, burning, dull?)

Radiates / or another source says Region/Radiates (Does it start in one place, and move to another? What makes it move? (spleen injury pain can be felt in the shoulder, heart attack chest pain can radiate to the neck and jaw, kidney stones are associated with severe back/flank pain radiating to the groin, gallbladder pain can be felt in the right shoulder blade, a slowly bleeding abdominal aneurysm can cause abdominal pain radiating to the back)

Severity (Where is the pain on a scale of one (least) to ten (most))

Time (When did it start hurting? How frequently does it occur? How long does it last? Does it come and go? Get better or worse?) (Intermittent, hard to locate pain is common with problems of the abdomen.)

(If the onset and time categories seem to be redundant, think of the onset as WHY and the time as WHEN.)

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Allergies

Do you have any allergies, (including food, plants/pollen, insects and medications)? What type of reactions have you experienced when you were exposed? Any recent exposure?

Medications

Do you have any medical conditions or are you taking any medications? If so, what conditions do you have or what medications are you taking? Have you taken any in the past 12 hours?

(including prescription, over-the-counter, herbal)?

Don't ask if they are taking any drugs, as they may misunderstand and think you are accusing them of illegal activities. But if that might be the reason they are having problems, you certainly need to find out.

Diabetic? Cardiac history? Epilepsy? Asthma? Pregnant? Check for medic alert tag.

Example: if they are taking Viagra, giving them nitroglycerin could have serious side effects.

Pertinent past medical history

Have you experienced any recent falls, accidents or blows to the head? Have you ever been in any medical, surgical or trauma incidents? Are you under a doctor's care for anything? If appropriate: Have you experienced anything like this before?

(history of high blood pressure? recent surgery/illness? (complications?) Dehydrated? Didn't eat any breakfast? Lack of sleep? Substance abuse? Previous injury to same site? Same type of pain previously - was there a diagnosis? Same location of pain previously - is the pain the same this time?)

Last oral intake

When did you last eat or drink anything? What did you last eat or drink? This includes solids, liquids and medications. (Don't ask the victim "when was your last oral intake?").

Perhaps ask if oral intake over the past few days has been normal for them. Perhaps ask if urination and defecation have been normal.

Events leading to the incident

What were you doing before the accident happened? What were you doing when the incident occured? Why do you think this happened? (As in, why do you think you just fainted?)

Finally, you could ask: Is there anything else I should know?

Write down all the answers.

Then do a head to toe exam, starting by telling the victim what you are going to do. Keep explaining as you go along.

Head to toe exam

(in a simple secondary survey you hardly touch the victim, they do the moving around, but only if you do not suspect a spinal injury)

Visually inspect the body, including the scalp, face, ears, eyes, nose and mouth for cuts, bumps bruises and depressions.

(DOTS: Deformity, Open injuries, Tenderness, Swelling)

(DCAP BLTS deformities, contusions, abrasions, penetrations (another source says punctures/penetrations),

burns, lacerations, tenderness, swelling)

Look at face and lips (unusually wet or dry, pale, bluish, flushed, ashen; note abnormalities).

Check eyes (pupils - big, tiny, uneven size) ears, nose, ask them to open mouth; look for fluid or blood (don't try to control fluid coming from ears)

A significant percentage of people normally have pupils of slightly different size, but both should react to light the same way if, for example, you shine a flashlight in their eyes.

Determine skin appearance and temperature. Feel person's forehead with back of your hand to determine if it is cold or hot.

Write down all observations, including anything that does not look right.

Don't do the following if you suspect a spinal injury or move any body part you suspect was injured.

- Ask person to move head from side-to-side if there is no discomfort and if an injury to the neck is not suspected.

Note pain, discomfort or inability to move the neck.

- Ask person to shrug shoulders.

- Ask person to take a deep breath and blow out air.

Listen for changes in breathing and ask victim if he or she is experiencing pain during breathing.

Breathing (gasping, unusual noises, fast or slow, labored, noisy, gurgling, shallow or deep, pain when breathing, dry or productive cough)

Stridor = high pitched noise when breathing in; wheezing = high pitched noises when breathing out.

Ask if any pain in abdomen (which quadrant?)

(If they are vomiting, describe what is vomited, if diarrhea, describe the consistency.)

- Ask person to move hands, fingers, bend arm. Compare grip strength.

- Ask person to move feet, ankles, bend leg. Check one limb at a time.

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See also: How to pass a Red Cross written test

injuries quick facts

Anaphylaxis quick facts

Bloodborne Pathogens quick facts

CPR quick facts

AED quick facts

Common mistakes in Professional Rescuer CPR skills

Common mistakes in professional rescuer CPR skills - Lifeguard Training

Oxygen administration quick facts

First Aid for Public Safety Personnel study guide

fast, basic neurological exam

Cultural issues in first aid

 Updated Wednesday, January 29, 2014 at 12:34:31 PM by Mary Donahue - donahuemary@fhda.edu
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