PRIMARY and SECONDARY SURVEY in

EMERGENCY

Ns. Septa Meriana Lumbantoruan, S.Kep., M.S

 Langkah
Survey pada
Emergency
 • Prinsip 3A:
1. Aman diri : Pengunaan APD
2. Aman lingkungan
Sebelum 3. Aman pasien
Kontak • Identifikasi keadaan umum
dengan dengan mengecek respon:
AVPU : Alert, Verbal, Pain,
Pasien Unresponsive
Primary Survey
Meliputi: ABCDE
• Airway
• Breathing
• Circulation
• Disability
• Exposure
Pemeriksaan harus dilakukan dalam 2-5 menit

Lakukan Re evaluasi ABCDE

Tambahan primary survey: F,G,H

 • A :Airway + control cervical (verbal response,
cervical spine injury)
- Head tilt, chin lift or jaw thrust
- Log roll, finger sweep
PRIMARY - OPA or intubation

SURVEY: - Dengarkan suara nafas khususnya Gurgling dan

Airway Snoring
Cari tahu apa beda kedua suara nafas tersebut dan
bagaimana cara mengelola jalan nafas pada kedua
suara nafas tersebut
Pengelolaan
Jalan Nafas
 • Click here:
https://youtu.be/bW5ZwBAbBTE

Video
Learning
 • B :Breathing ( RR, Breath sound, movement)
1. Look, Listen and Feel
a. Look : ekspansi dada ada atau tidak
PRIMARY
b. Listen: suara nafas kedua paru
SURVEY c. Feel : perkusi adanya hipersonor, dullness
Breathing 2. Palpasi : krepitasi, flail chest
3. SpO2, Oxygen mask, BVM
 • C :Circulation (HR, hemorrhage) STOP
BLEEDING!
PRIMARY • Identifikasi sumber perdarahan internal
maupun eksternal
SURVEY
• Kaji nadi: kecepatan, kualitas dan kekuatan
Circulation • Kaji akral : hangat atau dingin
• Kaji tekanan darah (bila ada waktu)
 • D :Disability (GCS, pupil reaction,
PRIMARY lateralisasi)
SURVEY • Tanda laterasi: pupil isokor, dan tanda
laterasi lainnya (temukan)
Disability
Glasgow Coma Score (Adults)

Eyes Verbal Motor

1= do not open 1= nonverbal 1= none
2= open to pain 2= incomprehensible 2= extends to pain
3= open to voice 3= inappropriate 3= flexes to pain
4= open 4= confused 4= withdraws to
spontaneously 5= orientated pain
5= localizes pain
6= follows
commands
Diskusikan
A 19-year-old man is brought into the clinic after a head-on cycling
accident. The patient was not wearing a helmet. Upon presentation
his BP is 125/75 mm Hg, PR is 105 beats per minute, RR is 19
breaths per minute, and oxygen saturation is 100%. His eyes are
closed but open to command. He can move his arms and legs on
command. When you ask him questions, he is disoriented but able to
converse. What is this patient’s GCS score?
11
12
13
14
Silahkan menghafalkan
GCS
PRIMARY SURVEY Exposure

• E :Exposure / Environmental (wet clothes vs warm blanket, lacerations, log roll)

• Buka pakaian pasien namun cegah hipotermia (gunakan selimut)
1. D : deformity
2. O : open wounds
3. T : tenderness
4. S : swelling
 • F : Foley Catheter (indication or
contraindications)
Tambahan
• G : Gastric Tube (indication or
Primary contraindications)
Survey • H: Heart Monitor
• Re-evaluation
 Should not take more than 5 -10 minutes

Head to toe examination

Vital signs
Fingers in every orifice
Anamneses SAMPLE
SECONDARY S : Sign and Symptom

SURVEY A : Allergies
M : Medications
P : Pertinent past history
L : Last Oral intake
E : Events leading up to the illness/injury
In Bahasa SAMPLE = KOMPAK
(Keluhan, Obat, Makan, Penyakit, Alergi, Kejadian)
SECONDARY SURVEY

DIAGNOSTIC EXAMINATION RUJUKAN RUMAH SAKIT

(PASTIKAN ADA RUANGAN)
 • Airway management takes priority

• Treatment of bleeding can be delayed for a few

minutes if intensive resuscitation is necessary

Assignment • Any injuries which would lead to complications or

loss of function if diagnosis or treatment is delayed
of Priorities (peripheral vascular injuries, tendon and nerves
injuries, eye injuries, amputations of limbs)

• Closed fractures, dislocation and small soft tissue

wounds are the only lesions for which treatment can
be delayed for several hours
Evaluasi Pembelajaran
• Kerjakan kuis berikut
• https://www.proprofs.com/quiz-school/quizshow.php?title=primary-
survey&q=16
Praktek

• Praktekkan Primary Survey dengan seseorang

https://www.youtube.com/watch?v=ea1RJUOiNfQ
References
• Bickley, Lynn S. Buku Ajar Pemeriksaan Fisk dan Riwayat Kesehatan Bates. Edisi 8. Jakarta: EGC, 2009
• Hudak, Gallo. Critical Care Nursing. Philadelphia. JB. Lippincot Company, 2000
• Alexander, Jason, dr.
http://www.physicianeducation.org/downloads/PDF%20Downloads%20for%20website/Basic%20Trauma.pd
f retrieved 16.01.2012
• American College of Surgeons. (1997). Advanced Trauma Life Support. USA : First Impression
• Reihani, H., Pirazghandi, H., Bolvardi, E., Ebrahimi, M., Pishbin, E., Ahmadi, K., ... & Rahimi-Movaghar, V.
(2017). Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional
study of a trauma center in Iran. Chinese journal of traumatology, 20(2), 75-80.
• Farrohknia, N., Castrén, M., Ehrenberg, A., Lind, L., Oredsson, S., Jonsson, H., ... & Göransson, K. E. (2011).
Emergency department triage scales and their components: a systematic review of the scientific
evidence. Scandinavian journal of trauma, resuscitation and emergency medicine, 19(1), 42.
• Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J., ... & Rea, T. (2015). Part
5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association
guidelines update for cardiopulmonary resuscitation and emergency cardiovascular
care. Circulation, 132(18_suppl_2), S414-S435.