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Chapter 5
Primary and Secondary Survey
♦ KNOWLEDGE OBJECTIVES
- List the six emergency action principles.
- Explain why you do a primary survey in every emergency situation.
- Describe how to do a primary survey.
- List seven important pieces of information that should be provided to an EMS dispatcher. 5. List ten conditions that require you to summon more advanced medical personnel. 6. Explain why you do a secondary survey. 7. Describe when to do a secondary survey. 8. Describe how to do a secondary survey. 9. Define the key terms for this chapter.
♦ SKILL OBJECTIVES
After reading this chapter and completing the class activities, you should be able to
- Demonstrate a primary survey.
- Demonstrate a secondary survey.
- Make appropriate decisions about care when given an example of an emergency requiring you to do a primary and a secondary survey.
♦ OUTLINE
Introduction 71
Emergency Action Principles 71
Step One: Survey the Scene 71
Step Two: Check the Casualty for Unresponsiveness and Call Advanced Medical Personnel 73
Step Three: Do a Primary Survey and Care for Life-Threatening Conditions 74
Step Four: Do a Secondary Survey 77
Step Five: Keep Monitoring the Casualty's ABCs 88
Step Six: Help the Casualty Rest Comfortably and Provide Reassurance 88
♦ KEY POINTS
Emergency Action Principles
- Survey the scene.
- Check for responsiveness, and call EMS.
- Do a primary survey, and care for lifethreatening conditions.
- Do a secondary survey.
- Keep monitoring the ABCs.
- Help the casualty rest, and give reassurance.
Information to Provide to Dispatcher
♦ Where the emergency is located.
♦ Telephone number from which the call is being made..
♦ Caller's name.
♦ What happened.
♦ The number of people involved.
♦ Condition of the casualty(s).
♦ Care being given.
Primary Survey
♦ Check consciousness.
♦ Check ABCs
Airway/C-Spine.
Breathing.
Circulation.
Secondary Survey
♦ Interview the casualty and bystanders.
♦ Check vital signs.
♦ Do a head-to-toe exam.
Interview the casualty
♦ A = Allergies.
♦ M = Medications.
♦ ast medical history.
♦ E = Event before the incident.
P = P
♦ L =Last meal.
♦ LEARNING ACTIVITIES
Matching
Match each term with its definition. Write its letter on the line in front of the definition.
Terms
a. Emergency action principles
b. Primary survey
c. Vital signs
d. Symptom
e. Level of consciousness
Definitions
- A measure of the casualty's awareness of the surroundings
- The check for immediate life- threatening conditions
- Something the casualty tells you about how he or she is feeling
- The status of a casualty's breathing, pulse, and skin
- The steps that guide your actions as a first responder
Short Answer
Read each statement or question and write the correct answer or answers in the space provided.
What are the three parts of the secondary survey?
What are the six emergency action principles?
What is the purpose of the secondary survey?
What seven necessary pieces of informa- tion would you provide to a dispatcher?
What five questions should you ask during the interview with the casualty?
What equipment allows you to measure blood pressure by auscultation?
How would you write a blood pressure that was 70 millimetres of mercury (mm Hg) diastolic and 110 mm Hg systolic.
List at least six conditions in which you would summon more advanced medical personnel.
Which of the following information should you obtain in your interview of this casualty during the secondary survey?
a. Pain sites, allergies, current medications
b. Name, age, religion
c. Age, address, where his parents are
d. What happened, medical conditions, vital signs
When performing the secondary survey, what five items will you check when assessing this casualty's vital signs?
T F While you are performing your secondary survey, the casualty becomes unconscious and stops breathing. You should continue with the secondary survey.
♦ SELF-ASSESSMENT
Circle the letter of the best answer.
- Which one of these casualties should receive some form of care before you perform a secondary survey?
a. A conscious, cooperative casualty
b. A casualty with an obvious head injury
c. A casualty bleeding severely from an arm
d. A casualty complaining of pain in an ankle
- Which of the following techniques would you use in performing a head-to-- toe examination?
a. Visually inspect the entire body, starting with the head.
b. Gently run your hands over each arm and leg to feel for possible fractures.
c. Ask the casualty to take a deep breath and exhale, unless he or she complains of chest pain.
d. All of the above.
- The purpose of the secondary survey is to
a. Find injuries or conditions that are not immediately life-threatening.
b. Determine if the casualty is bleeding severely.
c. Survey the scene for hazardous conditions.
d. Find out if the casualty has medical insurance.
- Why should you do a primary survey in every emergency situation?
a. Because it will protect you from legal liability
b. Because it identifies conditions that are an immediate threat to life or that could become life-threatening
c. Because it will enable you to protect the casualty and bystanders from dangers at the scene
d. All of the above
- For which of the following individuals should you immediately summon more advanced medical personnel?
a. A 22-year-old man who, since last night, has had a fever and has vomited four times
b. A 70-year-old jogger experiencing severe knee pain after her morning run
c. A 40-year-old executive complaining that he has felt nauseated, sweaty, weak, and has had difficulty breath- ing for at least an hour
d. An 8-year-old who was hit on the leg by a baseball and now has a large bruise
- Which of the following should you give special attention to during a secondary survey?
a. The type of medical coverage the casualty has.
b. A medical-alert bracelet or wallet card.
c. The name and address of the casualty's nearest relative.
d. Identification cards found in the casualty's wallet.
- Which of the following is the pulse point most frequently used to determine pulse rate and quality during the secondary survey'?
a. Radial artery.
b. Temporal artery.
c. Carotid artery.
d. Popliteal artery.
- The normal breathing rate for an adult at rest is
a. 5 to 10 breaths per minute.
b. 12 to 20 breaths per minute.
c. 16 to 24 breaths per minute.
d. 20 to 32 breaths per minute.
- Why should you do a primary survey in every emergency situation?
a. Because it protects you from legal liability.
b. Because it identifies conditions that are an immediate threat to life.
c. Because it identifies conditions that could become life threatening if not cared for.
d. Because it enables you to protect the casualty and bystanders from dangers at the scene.
- Before beginning a primary survey, you should first
a. Position the casualty so that you can open the airway.
b. Survey the scene.
c. Check for responsiveness.
d. Call more advanced medical professionals for help.
- Which of the following conditions would you discover in a secondary survey?
a. Cardiac arrest.
b. Open fracture with severe bleeding.
c. Allergies to bee stings and penicillin.
d. All of the above.
- When taking a blood pressure, the point at which the pulse is first heard as the pressure in the cuff is released indicates the
a. Diastolic pressure.
b. Arterial pressure.
c. Systolic pressure.
d. Venous pressure.
- If a casualty is unconscious, you can still gather information about what may have happened by
a. Asking bystanders.
b. Checking medical alert identification.
c. Waiting for the casualty to regain consciousness.
d. a and b.
- Which of the following emergency action principles should you implement first at the scene of an emergency?
a. Survey the scene.
b. Do a primary survey.
c. Do a secondary survey.
d. Call more advanced medical personnel for help.
- Why should you follow the emergency action principles in every emergency?
a. They ensure that necessary care is provided for life-threatening emergencies.
b. They provide you with a detailed medical history for the casualty.
c. They lead you to a diagnosis of the casualty's illness or injury.
d. All of the above.
- Which of the following should you give special attention to during a secondary survey?
a. The type of medical coverage the casualty has.
b. A medical-alert bracelet or wallet card.
c. The name and address of the casualty's nearest relative.
d. Identification cards found in the casualty's wallet.
- Which of the following measuring methods will give you both a systolic and a diastolic blood pressure reading?
a. Palpation.
b. Auscultation.
c. Oscillation.
d. All of the above.
Answers to Exercises
Unit 5-Primary and Secondary Survey
Matching: (Pg. 70)
1. e 2. b 3. d 4. c 5. a.
Short Answer:
1. Interview of casualty and bystanders; vital signs assessment; head-to-toe exam. (Pg. 77) 2. Survey the scene check for responsiveness and call EMS if necessary; do a primary survey and care for life-threatening conditions; do a secondary survey; continue to monitor the ABCs; help casualty rest and give reassurance. (Pg. 71) 3. To systematically gather additional information about injuries or conditions that may need care. (Pg. 77) 4. Where the emergency is located; telephone number from which the call is being made; caller's name; what happened; the number of people involved; condition of the casualty(s); care being given. (Pg. 73) 5. What happened?; Do you feel pain anywhere?; Do you have any medical conditions?; Do you take any medications?; Do you have any allergies, particularly to medications? (Pg. 78) 6. Stethoscope and blood pressure cuff. (Pg. 83) 7. 110/70 (Pg. 83) 8. Unconsciousness or altered level of consciousness; breathing problems (difficulty breathing or no breathing); persistent chest or abdominal pain or pressure; no pulse; severe bleeding; vomiting blood or passing blood; suspected poisoning; seizures; severe headache; slurred speech; suspected or obvious injuries to head or spine; suspected broken bones. (Pg. 74)
Case Study 5.1:
1. c (Pg. 76) 2. b (Pg. 77) 3. Pulse; Respirations. (Pg. 79 - 84)
Case Study 5.2:
1. d (Pg. 72) 2. a (Pg. 77) 3. Level of consciousness; pulse rate and quality; breathing rate and quality; skin characteristics; blood pressure. (Pg. 79 - 84) 4. F. (Pg. 77)
Self-Assessment:
1. c (Pg. 74) 2. d (Pg. 85) 3. a (Pg. 78) 4. b (Pg. 74) 5. c (Pg. 74) 6. a (Pg. 71) 7. b (Pg. 73) 8. d (Pg. 77) 9. b (Pg. 78) 10. c. (Pg. ??) 11. b (Pg. 78) 12. a (Pg. 79) 13. b (Pg. 80) 14. b (Pg. 74) 15. b (Pg. 71) 16. c (Pg. 77) 17. c (Pg. 82) 18. d (Pg. 78) 19. a (Pg. ??) 20. a (Pg. ??) 21. b (Pg. ??) 22. b (Pg. ??) 23. b (Pg. ??) 24. c (Pg. ??) 25. d (Pg. ??) 26. c (Pg. ??) 27. b (Pg. ??) 28. a (Pg. ??)
□ Open the airway.
♦ If a c-spine injury is not suspected, tilt head back and lift chin.
□ Recheck breathing.
♦ Look, listen, and feel for about 10 seconds.
If person is not breathing...
♦ Keep head tilted back.
♦ Pinch nose shut.
♦ Seal your lips tightly around person's mouth.
♦ Give 2 slow breaths, each lasting about 1 1/ seconds.
♦ Watch to see that the breaths go in.
□ Check for pulse
♦ Locate Adam's apple.
♦ Slide fingers down into groove of neck on side closer to you.
♦ Feel for pulse for 10 seconds.
□ Check for severe bleeding
♦ Look from head to toe for severe bleeding.
If person has a pulse and is not breathing...
♦ Do rescue breathing.
If person does not have a pulse...
♦ Begin CPR.
□ Breathing
Determine breathing rate.
♦ Note breathing rate or whether the person is
♦ Gasping for air.
♦ Making unusual noises as he or she breathes.
♦ Breathing excessively fast or slow.
♦ Experiencing pain when breathing.
□ Skin characteristics
♦ Feel person's forehead with back of your hand.
♦ Look at person's face and lips.
Note if skin is
Cold or hot.
Unusually wet or dry.
Pale, bluish, or flushed.
♦ Check capillary refill.
♦ Blood pressure
(Note: Blood pressure skill sheets follow.)
□ Do head-to-toe examination
♦ Look carefully for bleeding, cuts, bruises, and obvious deformities.
♦ Ask if person has pain or discomfort.
♦ Note any abnormalities.
□ Check head
♦ Feel the skull for blood, lumps, or depressions.
♦ Look for fluid or blood in the ears, nose, or mouth.
♦ See if pupils respond to light.
♦ Note any changes in level of consciousness.
□ Check neck
♦ Feel sides and back of the neck.
♦ Feel shoulders and collarbone.
♦ Ask person to shrug shoulders.
□ Check chest
♦ Feel ribs and sternum.
♦ Ask person to take deep breath and blow air out.
□ Check abdomen
♦ Apply slight pressure to each side of abdomen, high and low.
