Primary and Secondary Survey

dr. Fatah Abdul Yasir

RS PKU Muhammadiyah Gombong
Primary Survey
 Primary Survey

Airway Circulation
(with C-Spine Breathing (with Hemorrhage
control) Control)

Exposure Disability
Airway (with C-spine control)
Airway partial obstruction

• Upper Airway
– Snoring
– Stridor
– Gurgling

• Absent breath sounds may

indicate complete obstruction or
respiratory arrest
 Management
• Simple Maneuver
Positioning, head tilt, chin lift, jaw trust
• Definitif Airway
– Endotracheal / nasotracheal intubation
– Surgical chricothyroidotomy
C- Spine Control
Breathing
• Sound of breaths
Auscultation
• Sonor, hypersonor, or dullness
Percussion
• Quality of breathing Palpation
• Tracheal deviation
• Symmetrical of Thorax Inspection &
• Open wound, bruises, crepitus, abnormal chest wall motion
Breathing Assessment
• Management
– Ventilate with 100% oxygen, monitor oxygen
saturation
– Consider immediate needle thoracostomy for
suspected tension pneumothorax.
– Closed the wound for open pneumothorax
– Consider tube thoracostomy for suspected
hemopneumothorax.
Circulation with Hemorrhage Control
 Skin Color Blood Pressure

Circulatory
status
pulse
Capillary Refill carotid/femoral/radial
• Management
– Place two large-bore peripheral IV catheters.
– Begin rapid infusion of warm crystalloid solution, if
indicated.
– Apply direct pressure to sites of brisk external
bleeding.
– Consider central venous access if peripheral sites are
unavailable.
– Consider pericardiocentesis for suspected pericardial
tamponade.
– Consider left lateral decubitus position in late-
trimester pregnancy
Disability
 Screening Neurologic
Orientation,
Limb
Pupil size & Glasgow
Strength &
Reactivity Coma Scale
Movement
Score
• Consider measurement of capillary blood
glucose in patient with altered mental status
Exposure
Completely disrobe the patient
• Inspect for burns
• Toxic exposure

Log roll patient, maintaining neutral

position, and in-line neck stabilization
• To inspect and palpate thoracic spine, flank,
back, and buttock
Secondary survey
 Secondary survey
• Secondary survey refers to a more thorough
history and physical examination.
• Performed after life-threatening conditions in
primary survey are stable or improving and
the patient is being transported
• If the primary survey fails to indicate that the
injured patient is critical, then the provider
proceeds on to the secondary survey.
 History
• Allergies to medications
• Medications
• Past medical history / Pregnancy
• Last eaten/meal
• Events leading up to the injury
Head-to-toe examination for rapid identification
and control of injuries or potential instability
 Physical Examination
• Identify and control scalp wound bleeding with
direct pressure, sutures, or surgical clips.
• Identify facial instability, potential for airway
instability.
• Identify hemotympanum.
• Identify epistaxis or septal hematoma; consider
tamponade or airway control if bleeding is profuse.
• Identify avulsed teeth, jaw instability.
• Evaluate for abdominal distention and tenderness.
 Physical Examination
• Identify penetrating chest, back, flank, or abdominal
injuries.
• Assess pelvic stability, consider pelvic wrap or sling.
• Inspect perineum for laceration or hematoma.
• Inspect urethral meatus for blood.
• Consider rectal examination for sphincter tone and
gross blood.
• Assess peripheral pulses for vascular compromise.
• Identify extremity deformities and immobilize open
and closed fractures and dislocations.
Thank You
 Referensi
• Ambulance Victoria. 2014. Clinical Practice Guideline
for Ambulance and MICA Paramedics.
• American College of Surgeon. 2011. Advanced
Trauma Life Support
• Mattox, Kenneth L. et al. 2013. Trauma. Mc Graw Hill
• Malang Trauma Service. 2014. Basic Trauma Life
Support (Pertolongan Hidup Dasar Trauma).
• Tintinalli, J.E.2011.Tintinalli’s Emergency Medicine A
Comprehensive Study Guide.Mc Graw Hill