Trauma: Trauma Survey

Definition

• Primary Survey: Initial “A-B-C-D-E”
• All Traumas Start with an Efficient Primary & Secondary Survey
• For Patients in Cardiac Arrest Outside of the ED Thoracotomy Indications:
  • Adjusted Algorithm: “A-A-B-B-C-C”
    • Airway
    • Access
    • Bilateral Chest Tubes
    • Blood Products
    • Cardiac US
    • CPR (ACLS)
  • Includes Situations Such as “Unwitnessed” Blunt Trauma, Penetrating Trauma > 15 Minutes & Facilities with No Surgical Capabilities

Airway

• Goal: Establish Patency of Airway
• Assessment:
  • Check if Talking
  • Watch for Noisy or Diminished Breath Sounds
• Intubation Indications:
  • Unable to Protect Airway
  • GCS ≤ 8 Mn
  • Unconscious
  • Noisy Breathing
  • Expanding Hematoma
  • Neck Emphysema
  • Severe Inhalation Injury
    • *See Trauma: Burns
• Intubation: *See Surgical Principles: Endotracheal Intubation
• If Unable to Intubate: Cricothyroidotomy
  • *See Trauma: Emergency Surgical Airway
  • Possible Causes:
    • Massive Facial Trauma
    • Laryngospasm
  • Needle Cricothyroidotomy if Age < 10-12 (Avoid Subglottic Stenosis)
  • Tracheostomy Not in Trauma

Breathing

• Goal: Assess Pulmonary Function
• Assessment:
  • Respiratory Rate & Rhythm
  • Chest Wall Movement
  • Lung Auscultation
  • Oxygen Saturation/ABG

Circulation

• Goal: Assess Effectiveness of Cardiac Output
• Assessment:
  • Blood Pressure
  • Heart Rate
  • Capillary Refill
• In Trauma Always Secure: Two Large Bore (16 or 18-Gauge) Peripheral IV’s
  • If Unsuccessful: Intraosseous (IO) Cannulation
    • Peds: Proximal Tibia (Distal Femur #2)
    • Adults: Sternum (Proximal Tibia #2)

Disability

• Goal: Assess Neurological Status
• Assessment:
  • Level of Consciousness
  • GCS
  • Pupil Response
  • Blood Glucose Level
• Glasgow Coma Scale (GCS) Mn