Primary and Secondary Survey Pre Hospital

Ns. Mohammad Ali Hamid

PROGRAM STUDI S1 KEPERAWATANFAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH JEMBER

Tujuan Pembelajaran

UmumSetelah mengikuti mata kuliah ini mahasiswa akan dapat melakukan primary survey dan secondary survey pre hospital

Khusus Menjelaskan langkah – langkah dalam

primary survey & secondary survey pre hospital

Menjelaskan prioritas pemeriksaan Menjelaskan intervensi yang harus dilakukan

dalam primary survey & secondary survey pre hospital

Scene Survey Is scene safe?

Protect Self/Team (Universal Precautions).

Protect your patient. Find Clues for Mechanism of injury/history.

Number of patients.

PRIMARY SURVEY Adult / Pediatric priorities same Identified the life-threatening conditions and simultaneously

managed A: Airway maintenance with cervical spine

protection B: Breathing and ventilation C: Circulation with hemorrhage control D: Disability ( Neurologic status ) E: Exposure / Environmental control: Undress the

patient & prevent hypothermia

Airway Upper airway obstruction kills. Talking patients have an open airway. Common causes of obstruction: tongue,

foreign objects, swelling, direct trauma Signs & Symptoms: impaired speech,

cyanosis, irregular breathing, stridor, coughing.

Airway Maneuvers Head tilt, chin lift (Caution!) Jaw thrust Left lateral position Heimlich Artificial airways : oropharyngeal,

nasopharyngeal

Cervical Spine Injury

Include in airway management.

Suspect in all blunt trauma

victims, unconscious patients.

Stabilize and immobilize neck.

Don’t use head-tilt.

Breathing Breathing is different from airway. Look Listen Feel Acute Respiratory Insufficiency: abnormal

respiration , use of accessory muscles, nasal flaring, cyanosis

Breathing Supplemental Oxygen is a drug! Spontaneous respiration:

Nasal cannula, face masks, rebreather and non-rebreather masks

Non-breathing patients:Mouth to mask ventilation, Bag-

Valve-Mask

Circulation Assess circulatory function:

Central & peripheral pulse

Pulse rate and characterSkin color, moisture & temp

Circulation Identify life-threatening hemorrhage:

Rapid , Arterial , Massive amount Control hemorrhage:

Direct pressure , Splint and elevate, MAST, Tourniquet

Identify internal hemorrhage.

Disability

Identify level of consciousness

A-alert

V-verbal commands

P-pain

U-unresponsive

Pupil response and size

Expose Remove clothing as needed .

Maintain body temperature.

Inspect/palpate the entire

body.

Log roll to expose back.

The rapid Assessment Neck

Inspect/palpate : DCAP – BLS, JVD, Trache deviation, pain

ChestInspect/palpate : DCAPP – BLS, Auscultate for breath sounds, Percuss

AbdomenInspect/palpate : DCAP – BLS, Tenderness

The rapid Assessment

PelvisInspect/palpate DCAP – BLS, TIC

MusculoskeletalInspect/palpate DCAP – BLS, TIC, PMS

Load and Go

Kriteria “Load and Go” Obstruksi jalan nafas yg tdk dpt diatasi scr mekanik(suction,

forceps atau intubasi) Henti jantung karena trauma Keadaan yg menimbulkan pernafasan tdk adekuat (open

pneumothotax, flail chest, tension pneumothorax, trauma dada yg luas

Shock Trauma kepala tdk sadar, pupil anisokor/penurunan

kesadaran Nyeri abdomen Pelvis tdk stabil Fraktur femur bilateral

SECONDARY SURVEY History

A. AllergiesM. Medications currently usedP. Past illness / pregnancyL. Last mealE. Events / Environment related to

injury

HISTORYMechanisms of injury

Blunt Automobile collisions

Seat belt usage Steering wheel deformation Direction of impact Ejection of passenger form the vehicle

Burns and Cold injury Inhalation injury and CO. intoxication in fire field

Hazardous environment Penetrate

Anatomy factors Energy transfer factor

Velocity and caliber of bullet Trajectory Distance

SECONDARY SURVEY Physical Examination

Head and Maxillofacial Inspect and palpate head and face

(DCAP – BLS, TIC) Battle’s sign Pupils and LOC Raccoon eyes Ears and nose for CSF Mouth Skin : pale, cyanosis, diaphoresis

SECONDARY SURVEY Reassess ABCs Vital sign Physical Examination

C-spine and Neck

Inspect for signs of injury, tracheal deviation- Palpate for tenderness,DCAP - BLS, subcutaneous emphysema- Auscultate for carotid bruits

SECONDARY SURVEY

Physical ExaminationChest

Inspect ant, lat and post chest for injury, use of accessory- Auscultate for breath sounds- Palpate for DCAPP – BLS, TIC- Percuss

SECONDARY SURVEY Physical Examination

Abdomen- Inspect & palpate for signs of injury

or bleeding DCAP - BLS- Auscultate for bowel sounds- Percuss

SECONDARY SURVEY

Physical ExaminationMusculoskeletal- Inspect & Palpate extremities for signs

of injury (DCAP – BLS, TIC, PMS)- Assess pelvis (DCAP – BLS, TIC)

SECONDARY SURVEY Physical Examination

NeurologicDetermine GCS scoreRe-evaluate pupilsSensory / motor evaluation Maintain immobilizationPrevent secondary CNS injury Early neurosurgical consultation

Reassessment Survey

The level of Consciouss Reassess ABCs Neck, chest, abdomen, pelvis, ekstremitas Focused Assesment of Injuries Check Intervention( patient is not stable every 5 minute, patient

is stable every 15 minute)

SUMMARY

Initial assessment & management of multiply injured patient

Primary survey ( ABCDEs )

Resuscitation & monitor ( life-threatening problems )

Secondary survey ( head-to-toe, history )

Questions?

Referrence1. Lanros & Barber (1997) Emergency Nursing :

with Certification, Preparation, & Review.USA : Appleton & Large

2. Springhouse corporation book division (1985). Nurse’s Reference Library : Emergencies. Pennsylvania : Springhouse corporation

3. _____ (1998) Pertolongan Dasar Gawat Darurat Trauma : Malang.RSUD Dr Saiful Anwar

4. http://www.adhb.govt.nz/trauma/T_guidelines/primary_survey.htm

5. Suhttp://sprojects.mmi.mcgill.ca/trauma/educ/tutorials/surveys.htmrvey