The secondary survey is a means by which you can determine if there are any medical or injury-related problems which not immediately life-threatening, may become so if left undiscovered or unattended.
Remember, you will now be taking into consideration information from
many sources which are:
1. The interview-the patient letting you know what happened
2. Witnesses to the accident
3. The comprehensive hands-on, head-to-toe exam ofthe patient
4. The scene itself, what appears to be the mechanism of injury, medications or other substances lying about, any unusual odors or smoke
The secondary survey requires the use of a few simple instruments and equipment: CPR. Mouth-to-mouth ventilation is accomplished by sealing off the patient's nose, covering the patient's open mouth with your own, and exhaling deeply into it.
1. Blood pressure cuff
2. Stethoscope
3. Flashlight
4. Heavy-duty bandage scissors
5. Watch
6. Thermometer
These instruments can be carried in a small canvas pack or tackle box so they will be accessible anywhere on the ship.
Interview. When you have finished your primary survey and have established that there are no immediate life-threatening problems, you can conduct the secondary survey, beginning with the interview.
1. Position yourself near the patient.
2. Identify yourself (speak in a normal voice) and reassure the patient (a simple touch on the shoulder or arm can help a lot).
3. Obtain basic information-patient's name, age, and a quick explanation of what is wrong (this will help you assess your patient's level of consciousness as well as giving important information). Leave the details for later.
4. If there was an injury, ask how it happened. Try to record the information using the patient's exact words if possible. If this is an illness find out how long the patient has felt ill.
6. Find out if the problem has happened before or if the patient has ever been sick like this before. It is very important at this time to find out if any medications are being taken.
6. Ask about allergies to medicines (look for medical identification devices such as the Medic Alert bracelet or necklace).
You may now quickly ask any witnesses if their impression of what happened differs significantly from what the patient just told you.
Hands-on exam. Move now to the comprehensive hands-on exam.
Determine level of consciousness. There are many "systems" that may be used as guides in this important assessment. The simplest method is nicknamed AVPU.
A = Alert and oriented. The patient is aware of what is happening around him.
V = Verbal. The patient responds to your voice but is confused.
P = Painful stimuli. The patient may not respond at all to your voice or will not obey simple commands (like "open your eyes," "blink," "open your mouth"), but he does withdraw from painful stimuli (being pinched).
U = Unconscious. The patient is unresponsive even to painful stimuli.
A more complex, but potentially more informative, method of assessing your patient's level of consciousness is the Glasgow coma scale (GCS). This scale is particularly useful if information is being given by the ship's officer via radio to a shores ide physician. The Glasgow coma scale is universally understood and is the least ambiguous of all the methods of describing level of consciousness.
Determine the vital signs, which include pulse, respirations, blood pressure, and temperature. This process should take about one or two minutes.
Pulse. You are concerned with two factors (the rate and the character ofthe pulse). For purposes of simplification we will consider an adult pulse rate ofless than 60 as slow, between 60 and 80 as normal, and greater than 100 as fast. Pulse rate varies considerably among individuals and this is only a rough guide. The pulse character is described as regular or irregular in regard to rhythm and full (strong) or thready (weak) in regard to force. The best approach is to measure the radial pulse or alternatively, if the radial pulse is too weak, the carotid pulse.
