12/4/2023

PRIMARY SURVEY & SECONDARY SURVEY

MISS MUHAINI MOHAMED

LECTURER
PIUC
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LEARNING OUTCOMES
At the end this session, students should able to:
1. define what is primary and secondary survey

2. list the purpose of primary and secondary survey

3. list the 3 major components of primary care

4. describe of the role of the primary survey in patient

assessment and management
5. perform correctly the primary survey & secondary
survey to safe life of patient.

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▪ DEFINITION OF PRIMARY & SECONDARY SURVEY

PRIMARY SURVEY
▪ Is a systematic SECONDARY SURVEY
process assessment ▪ Repeat initial
of traumatic assessment and
patients to perform detailed and
identified life- systematic and quick
threatening full ( head to toe)
conditions and to examination then
start immediately only give a
life-saving treatment.
treatment

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PURPOSES

PRIMARY SURVEY
1. To safe patient life by identify
life –threatening condition.
2. Perform initial assessment
and make critical intervention SECONDARY SURVEY:
for stabilize patient. 1. To find any
3. Find the problems and treat significant injuries
immediately . that may have
4. To ensure appropriate been missed in
treatment given to coincide primary survey by
with the injury patient at right perform physical
time. examination
5. To determine how traumatic ( head to toe)
events occurs and will give a
clues to us how bad/ critically
injury to patient impact from
mechanism of injury.

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PRIMARY SURVEY ASSESSMENT

 Is a systematic method of evaluation of patient’s
physical conditions.
 The assessment is the process looking for, asking
for and recognising the symptoms and signs of an
abnormal condition.
 It includes interviews and physical examinations.
 The patient assessment process includes the
following component:
1) Size-up the scene
2) Initial Assessment, threats and life-threatening
conditions

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3. Perform physical examination of the patient, looking

for signs off illness or injury
4. Obtain vital signs to identify how patient are
tolerating their illness and injury.
5. Perform history taking that may explain the physical
findings and abnormal vital signs
6. Prepare patient for transport and continuously
assess for changes in his condition

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SCENE SIZE-UP

 A scene size-up is an immediate evaluation of an

emergency scene for safety of health care providers,
patients and bystanders.
 Given some clues of high index's suspicious of injury
(MECHANISM OF INJURY -MOI), nature of illness
and numbers of patients at the scene.

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 All patient assessment, involves the following steps:

1) U-Universal precaution
2) H-Hazard ( oncoming traffic, crime scene, fire,
smoke, downed electrical lines)
3) E-Extra Resources
4) N-Number of Victim
5) T-Types of Injury
6) A-Accessibility to the area
7) M-Means of injury

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ESSENTIALS MEDICAL EQUIPMENT TO THE SCENE

 Medical equipment to be taken to the scene are :

1) Personal protection equipment
2) Long backboard with effective strapping & head
motion restriction device
3) Appropriate sized rigid cervical extrication collar
4) Airway kits ( separate section for adult or paediatric
patients)- oxygen, Airway and intubation equipment
Bag valve mask ( BVM), Suction
5) Trauma box
6) Assumes all body fluids present a possible risk of
infection.

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MECHANISM OF INJURY
 Assess the severity of injuries on trauma patient by
evaluating the amount of force applied to the
patient’s body

NATURE OF ILLNESS
 To look for clues to determine the nature of illness
by gathering information from the patient and
people on scene and to observe the actual scene.

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PATIENT ASSESSMENT PROCESS

Airway Assessment and cervical spine protection
 The awake, alert patient who is able to speak with
normal voice.
 An obstructed airway can be cause or result of
decreased level of consciousness.
 Steps to assess the airway:

Look
▪ Look at face, neck, oral cavity and chest

1. Assess for obvious sign of maxillofacial or neck trauma

2. Foreign body, swelling, blood, gastric contents in the

mouth
3. Paradoxical movement of the chest and abdomen- “
sea-sawing

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4. Accessory muscle use ( head bobbing in infants)

5.Suprasternal, intercostal or supraclavicular recession
6. Tracheal tug ( downward movement of the trachea
with inspiration)

Listen: Listen for breath sound

1. Snoring sounds caused by partial occlusion of the
pharynx by the tongue
2. Gurgling sounds indicative of fluids in the airway (
secretion, blood, vomit)
3. Inspiratory stridor reflecting upper airway
narrowing and obstruction
4. Absent breath sound may indicate complete
obstructions or respiratory distress

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AIRWAY MANAGEMENT/ INTERVENTION

 To make sure airway patent before given any
supplemental oxygen.
 Open airway with basic manoeuvres such as the chin
lift ( non-trauma case) or jaw thrust ( trauma).
 Immobilize and protect the neck using manual in-
line stabilization in securing patient airway for
protection potential risk of spinal injury.
 Oxygen: 15L/min using mask with reservoir bag
 Inspect any foreign body in mouth
 A yankauer suction catheter is used to suction
blood, vomit or secretion

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PATIENT POSITIONING
 Unconscious patient should turned into recovery
position in order to prevent tongue falling down
back into the pharynx ( medical emergencies),
obstructing the upper airway.
 This position also allows gastric contents and other
fluids ( blood, secretion) to flow freely out of the
mouth.
 In unresponsive spontaneously breathing trauma
patient to lateral trauma position
 A stiff neck collar is applied in the supine position
and the patient log-rolled into the lateral position.
 Insert oropharyngeal airway if no gag reflex to
protect the airway.
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 If unresponsive patient ( respiratory arrest) CPR

should be initiated and attempt.

SUCTION
 To maintain airway patency.

 Use a wide-bore suction catheter ( yankauer).

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BREATHING ASSESSMENT & MANAGEMENT

 Identify life-threatening chest injuries:
1. Tension Pneumothorax
2. Open Pneumothorax
3. Massive Pneumothorax
4. Flail chest
5. Blast lung

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ASSESSMENT OF BREATHING & VENTILATION

 Assess adequacy of an airway an breathing.

 Look for skin colour, respiratory rate, respiratory
effort and symmetry chest movement.
 look for sign of airway and breathing compromise
such as noisy breathing ,dyspnoea, use of accessory
muscle, nasal flaring and use of accessory muscle in
children and laboured breathing.
 In trauma patient the chest should examined for
sign of chest injury.

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COLOR
 Assess for central cyanosis

RESPIRATORY RATE
 Assess the changes of respiratory rate, the first indicator
of deteriorating respiratory and circulatory function.
 The inability to speak full sentences or count to 10 in one
breath are indirect indicators tachypnoea is present.
 Tachypnoea indicates either hypoxia or compensation for
metabolic acidosis ( eg diabetic ketoacidosis, shock)
 Reduce RR- reduced respiratory drive fatigue induced
hypoventilation.

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RESPIRATORY EFFORT
 Use accessory muscle and intercostal recession
indicates increase effort of breathing, usually result
of lower airway obstruction ( asthma, COPD)
 Recession is more prominent in children due to
increased chest wall compliance and may be
subcostal, intercostal and even sternal in young
infants.
 Tracheal tug, nasal flaring and grunting are further
indicates of increased respiratory effort in paediatric
patient.

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RESPIRATORY SYMMETRY
 Assess the symmetrical chest movement
 Asymmetrical indicates- pathology on the side with
reduced movement. E.g: Pneumothorax,
haemothorax, pleural effusion.
 Look for paradoxical motion throughout the
breathing cycle indicative flail segment.

SIGN OF INJURY
 Assess of bruising, deformity and wounds.

 Check for axilla and back.

 Any penetrating wound.

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FEEL
 Palpate the neck and chest wall to elicit areas
tenderness or wounds.
 Note crepitus from fracture ribs or subcutaneous
emphysema ( pneumothorax).
 In low light hands placed on the chest to assess for
the presence of chest wall movement and symmetry.
 The position of trachea should be noted.
 Percussion is unreliable in a noisy environment.
 Feel the percussion quality and enables differentiate
of hyper-resonance or dullness from normal.
 A dull sound ( haemothorax or pleural effusion)
 Hyper-resonance- ( pneumothorax)

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LISTEN
 Conscious patient should be asked about any pain
on inspiration & difficulty breathing.
 Listen to the breathing. Note any wheeze or
prolonged expiratory time suggestive lower airway
obstruction.
 Auscultate the chest with stethoscope.
 A slight unilateral wheeze – indicator of an evolving
pneumothorax in trauma patient.
 Confirm bilateral and equal breath sound.
 Absent breath sound may be due to pneumothorax,
haemothorax, pleural effusion.
 Assess for sounds such as wheezes or crackles.

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RISE N FALL AND TWELVE

 Can be used to remember the
components of respiratory
assessment.
T- Trachea
 R-Respiratory rate
 I-Injuries W –wounds or
 S-Symmetry of movement hematoma
 E-Effort of breathing E-Emphysema
( subcutaneous)
 N- Neck L-laryngeal
crepitus/disruption
 F-Feel V-Venous
 A-Assess resonance Distension
 L-Listen to booth side of the E-Examine fully-
chest
 L- Look in both axilla & at the open collar
back
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MONITOR

 A pulse oxymeter should be attached and oxygen

saturations noted.
 Give supplemental administration oxygen prevent
respiratory distress and failure.
 No contraindication elevation of the head or sitting
position.

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CIRCULATION ASSESSMENT & MANAGEMENT

Assess circulation: Control External Bleeding

 Assessing patient’s mental status.
 A patient’s mental status is assessed by their level
of responsiveness, response to external stimuli and
orientation to time and place.
 The patient responsiveness can be evaluated using
the mnemonic AVPU:
 A- Alert
 V-Responsive to Verbal Stimulus
 R-Responsive to pain
 U-Unresponsive

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To assesses perfusion:
 Skin colour, skin temperature to identify any sign &
symptoms of shock
 Monitor vital sign as BP, PR- hypotension and
tachycardia indicates hypovolemic shock.
 Check capillary refill if more than 2 second it is
indicate poor perfusion due to hypovolemic.
 To control bleeding, apply direct pressure or
bandage presure, elevation, look for pressure
points stop the bleeding
 Insert 2 large iv bore/ branula for fluids
replacement.

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DISABILITY
 Check for neurological status.
 Check level of consciousness patient, pupil size &
reaction by using Glascoma Scale(GCS).
 It also can test for alert, verbal response, response
to pain and unresponsive.
 Identify any deformity- fracture or open fracture
 If any fracture, immobilization and splint the
affected area.

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EXPOSED
 All patient with trauma , we must exposure or
remove all cloth to identify any hidden injury.

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PRIORITY CARE OF PATIENT’S

 Difficulty breathing
 Poor general impression
 Unresponsive with no gag reflex
 Severe chest pain
 Sign of poor perfusion
 Uncontrolled bleeding
 Unresponsive but unable to follow commands
 Severe pain
 Inability to move any part of the body

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RAPID TRAUMA SURVEY

 Requires only 60-90 seconds head to toe
examinations
 DCAP-BTLS
 D Deformities
 C Contusions
 A Abrasions
 P Punctures/ Penetrations
 B Burns
 T Tenderness
 L Lacerations
 S Swelling

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RAPID PHYSICAL EXAMINATION

 Maintain spinal immobilization while checking

patient ABC’s
Assess the head
 Crepitation's

 Massive bleeding

 Airway obstruction

 Ask about pain and tenderness

Assess the neck

 JVD

 Tracheal Deviation, after checking , apply a cervical

spine immobilization collar

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Assess the chest

 After check DCAP-BTLS

 Watch the chest rise and fall with breathing

 Feel for grating bones as a patient breathes and

listen to breath sounds

Assess of abdomen
 Look for any obvious injuries, bruises or bleeding

 Evaluate for tenderness and any bleeding

 Also do not palpate too hard

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Assess the pelvis

 Look for any signs of obvious injury, bleeding or
deformity
 Then press gently inwards and downward on the pelvis
bones.

Assess the extremities

 Look for obvious injuries
 Feel for deformities and then assess the pulse, motor
function as well as sensory function

Assess the posterior body/ roll the pt’s with spinal

precautions
 Feel any tenderness, deformity and open wounds
 Carefully palpate from the neck to pelvis and look for
obvious injuries.

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3 MAJOR COMPONENTS IN PRIMARY TRAUMA SURVEY

 Medical History
 Baseline vital signs
 Physical examination

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SECONDARY SURVEY
 Visualize, and palpate using DCAP-BTLS
 Look at the face
 Inspect the area around the eye, eyelid ( raccoon
eye)
 Examines the eyes
 Pull the patient’s ear forward to assess or bruising
 Use a penlight to look for drainage or blood in the
ears
 Look for bruising and laceration about the head
 Palpate the zygomas
 Palpate the maxillae

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 Palpate the mandible

 Assess the mouth and nose for obstructions &
cyanosis
 Check for unusual odours
 Look at the neck
 Palpate the front and the back of the neck
 Look for distended jugular veins
 Look at the chest
 Gently palpate over the ribs
 Listen for breath sounds
 Listen also the bases and apices of the lungs
 Look at the abdomen and pelvis
 Gently palpate the abdomen
 Gently compress the pelvis

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 Gently press the iliac crests

 Inspect all 4 extremities and
 Assess the back for tenderness or deformities

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THANKS
YOU
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