Secondary Survey Prioritization in a Wilderness Emergency

QUESTION

You and friends are snowshoeing in the mountains during winter, wearing backpacks. It has been about 25 deg F (-4C) most of the day. You come upon a 35-year-old man off to the side of the trail who appears to be breathing heavily and has a laceration on his forehead. You determine that the scene is safe and that this man is the only patient. You complete the MARCH primary survey and then start the secondary survey. What should you do first in the secondary survey? Group of answer choices Ask the patient when they last ate or drank water Cut off the patient’s jacket and snow pants to achieve proper exposure and put him in a sleeping bag Preform a detailed head to toe assessment and then put him in a sleeping bag Obtain a set of vitals

ANSWER

Secondary Survey Prioritization in a Wilderness Emergency

Introduction

In wilderness emergency situations, conducting a systematic assessment of a patient’s condition is vital to ensure appropriate care and decision-making. When you come across a 35-year-old man with a forehead laceration during a snowshoeing trip in the mountains, you’ve already completed the MARCH primary survey. Now, as you initiate the secondary survey, prioritizing the right steps is essential. This essay discusses the key considerations for conducting a secondary survey in this scenario.

Secondary Survey Overview

The secondary survey follows the primary survey (MARCH), which includes initial assessments of massive hemorrhage, airway, respiration, circulation, and head injuries. The secondary survey is a more detailed assessment aimed at identifying less obvious injuries or medical conditions that may have been missed during the primary survey.

Prioritizing the Secondary Survey

In this wilderness emergency scenario, the following steps should be taken in the secondary survey, prioritized for efficiency and safety:

1. Preform a detailed head to toe assessment: The primary goal of the secondary survey is to conduct a comprehensive head-to-toe assessment. Start by examining the patient’s head, checking for any signs of head injury or other injuries that may have been overlooked. Proceed systematically through the neck, chest, abdomen, pelvis, extremities, and back.

2. Obtain a set of vitals: While performing the head-to-toe assessment, it’s crucial to obtain a set of vital signs, including heart rate, respiratory rate, blood pressure, and temperature. This step provides valuable information about the patient’s overall condition and helps identify any signs of shock, hypothermia, or other medical issues.

3. Cut off the patient’s jacket and snow pants to achieve proper exposure and put him in a sleeping bag: Hypothermia is a significant concern in cold mountain environments. To prevent further heat loss and hypothermia, it’s essential to remove wet or cold clothing and insulate the patient with a sleeping bag or other thermal insulation.

4. Ask the patient when they last ate or drank water: In outdoor emergencies, assessing the patient’s hydration and nutritional status is essential. Dehydration or inadequate food intake can exacerbate the patient’s condition. However, this step can be performed concurrently with the head-to-toe assessment and vital signs check.

Conclusion

In a wilderness emergency, prioritizing the steps of the secondary survey is crucial for providing efficient and effective care to the patient. While all components of the secondary survey are essential, starting with a detailed head-to-toe assessment and obtaining vital signs should take precedence to identify and address immediate life-threatening conditions. Additionally, addressing hypothermia risk by providing proper insulation is vital in cold mountain environments. Remember that each step should be conducted systematically and thoughtfully to ensure the patient’s safety and well-being.