SECONDARY EXAMINATION

As already explained, the primary examination was to assess the site and the life threatening injuries to the casualties. The secondary examination is much more thorough and extensive. It includes a full-body assessment.

The secondary examination, a systematic full body survey from head to toe, is usually conducted in a relatively safe area. Be careful not to move the casualty unnecessarily until you are satisfied that there are no major injuries (e.g., neck or spinal injuries) not detected in the primary examination. Use common sense: do not remove wound dressings, pull off clothing attached to the wound, or probe the wound. During the examination:

Look for discolorations, wounds, unusual chest movements, deformities, penetrations, vomit, etc.

Listen for changes in breathing patterns, unusual breathing sounds, and grating noises made by the ends of broken bones.

Feel for deformities, wounds, swelling, abnormal hardness or softness, tenderness, spasms, and skin temperature.

Smell for any unusual odors coming from the casualty's body, breath, or clothing.

Special Emergency Care Procedures

Special emergency care procedures common to the emergency treatment of practically all casualties include:

Administering morphine

Intravenous infusion of fluids

Transporting an IV casualty

ADMINISTERING MORPHINE.\Morphine is the most effective of all available pain-relieving drugs. When administered properly, it can relieve severe pain and prevent shock.

As a dental assistant, you will not ordinarily administer morphine. Experienced medical personnel make the decision to administer this drug. But situations do arise, such as mass casualties, when you may be issued syrettes containing 1/4 grain of morphine (fig. 13-11).

You may give one syrette of morphine to a casualty suffering severe pain. You may give a second syrette only if a casualty's severe pain persists and at least 4 hours have passed since you administered the first syrette. After this, do not administer any more morphine unless told to do so by a medical or dental officer.

MORPHINE CANNOT BE GIVEN TO ALL CASUALTIES WHO SUFFER SEVERE PAIN. Administer morphine only if the pain is very severe and only if there is:

No head, neck, or spine injury

No chest injury

Figure 13-11.\Morphine syrette.

No airway obstruction or impairment

No wound of the throat, nasal passages, mouth, or jaws from which blood might flow to obstruct the airway

No evidence of severe or deepening shock

No loss of consciousness

If you administer morphine in a mass casualty situation, you should:

1. Select an injection site. The best site is the muscle on the back of the upper arm. If both arms are injured, you may use a thigh or buttock as an injection site.

WARNING

If a tourniquet has been applied to the arm or the thigh, you must inject the morphine between the tourniquet and the main part of the body, if no other extremity is available.

2. Disinfect the injection site if you have the time and the materials. Swab the injection site with alcohol or any skin antiseptic. If no antiseptic is available, wash the injection site with soap and water, or with plain tap water.

3. Remove the plastic hood from the syrette.

4. Grasp the wire loop at the end of the needle and push down on the loop until it is stopped by the guard. This will pierce the metal seal on the collapsible tube.

5. Pull on the wire loop and withdraw the wire completely from the needle. Throw the wire away. Do not touch the needle.

6. Thrust the full length of the needle straight through the skin at the injection site.

7. Inject the morphine by slowly squeezing the collapsible tube. Start squeezing at the end of the tube and work your way down toward the needle. Once all the morphine has been injected, withdraw the needle and massage the injection site for a few minutes to help circulate the morphine.

8. Record your treatment. Medical personnel who later provide treatment for the casualty must know when the morphine was administered. Record the treatment on the U.S. Field Medical Card (discussed later), and write the letter "M" and the time of the injection (e.g., M 0830), on the casualty's forehead. Use a skin pencil, or another semipermanent marking for this purpose. You should also attach the empty syrette to the casualty's shirt collar or to some other conspicuous part of the clothing.