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En Primary Survey
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Transcript of En Primary Survey
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