Simple secondary survey study sheetNote to on-line users: 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.
Rule #1 Don't make things worse
-don't aggravate injuries-(don't move anything you think
might be broken)
-don't move victim if you suspect a spinal injury unless you 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 it as you go along)
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Times to suspect a spinal injury:
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)
cracked or broken helmet (bicycle, motorcycle, football,
surfer's, industrial hard hat)
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)
stabbing or impalement near the spinal column
thrown from a motor vehicle or horse
incident involving a lightning strike
injury by rockfall or avalanche
broken windshield or deformed steering wheel
not wearing a seatbelt
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
unconscious in water 5 feet deep or less
any injury caused by an entry into shallow water
diving mishap or entering water from a height, involving a diving board, water slide, enbankment, cliff or tower
diving onto an object at the water surface or underwater
impact with water on an imperfect dive from a great height
hit by a boat, personal watercraft, skier, surfer, ski, or surfboard
hanging
snowmobile or motorcycle under rope or wire
closed vehicle rollover
closed vehicle crash with death of another occupant
skiing or sledding into a fixed object (like a tree)
spear tackling in football (using the head)
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 or head and complaining of pain
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 can be caused by:
see AEIOUTIPS above
fever
any condition that results in less blood flow to the brain
conditions resulting from mental, emotional or behavioral disorders
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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)
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.)
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causes of seizures
lack of oxygen
stroke
epilepsy
brain tumor
diabetic emergency
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
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Normal capillary refill is 2 seconds (not effective on very cold fingers)
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Normal respiration for an adult is 12 to 20 breaths per minute
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Normal pulse
Adult 60 to 80
Child 80 to 150
Infant 120 to 150
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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
Verbal: Responds appropriately to
verbal stimuli
Painful: Only responds to painful stimuli
Unresponsive: Does not respond; no gag or cough reflex
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Your palm is approximately 1% of your body surface, use this to estimate extent of burns
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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) 20-40 minutes every 2-4 hours (sometimes more often)
Elevate above heart level unless it causes more pain
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Simple secondary survey , 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.
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 do so 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 any numbness, tingling or loss of sensation? If so, where?
Do you feel pain anywhere?
Sometimes ask for details about pain:
OPQRST
Onset (What were you doing when it started hurting? What made it start hurting?)
Provokes ( What makes
it worse/better? Does it only happen after you eat? Does it only hurt when you breathe deeply?)
Quality (Is it a sharp pain, stabbing, cramping, aching, burning, dull?)
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)
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?) (Intermittent, hard to locate pain is common with problems of the abdomen.)
A llergies
Do you have any allergies, (including food, plants, insects and medications)? What type of reactions have you experienced when you were exposed?
Medications
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.
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?
(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?)
Last oral intake
When did you last eat or drink anything? What did you last eat or drink? (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.
Events leading to the incident
What were you doing before the accident happened? What were you doing when the incident occured?
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,
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)
Determine skin appearance and temperature. Feel person's forehead with back of your hand to determine if it is cold or hot.
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 vomiitng, 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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Signs of wound infection
(Especially watch punctures for early signs of infection.)
pain does not get better a few days after the injury
increasing pain, swelling or tenderness
small pimple over the wound
pus 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
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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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See also: How to pass a Red Cross written test
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
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