Primary Survey

Trauma Primary and Secondary Survey
Sarah Pearson Emergency Department Consultant Queens Hospital, Burton
Trauma Resuscitation
Aim

Structured approach to the assessment of severely injured patient and institution of lifelifepreserving therapy
Trauma

Structured Approach

rapid primary evaluation ABC . resuscitation of vital function more detailed secondary assessment emergency treatment initiation of definitive care
Trauma Assessment & Resuscitation

Technically longitudinal progression of events In reality often parallel or simultaneous
Treat problems as they are found
Trauma Assessment
Primary Survey

A B C D E
airway & cervical spine control breathing & oxygen therapy circulation & haemorrhage control disability & neurological status exposure & environment
DEFG
don t ever forget glucose
Trauma Assessment

A - airway and C-spine control C
direct clearance / gentle suction position to establish patent airway check adjuncts and definitive airway if used C - spine immobilisation
Pitfalls Beware of struggling patient paralysed patient unknown laryngeal # or airway transection Finger sweep

Airway Manoeuvres

Definitive airway

jaw thrust chin lift head tilt
ETT (oral or nasal)
Surgical airway
needle cricothyroidotomy (jet insufflation ) surgical cricothyroidotomy (mini(mini-tracheostomy) tracheostomy

Adjunts

OroOro-pharyngeal airway NasoNaso-pharyngeal airway
Trauma Assessment

B- Breathing with oxygen therapy

chest wall and abdominal inspection check for air shift palpation, percussion and auscultation high flow oxygen
Pitfalls

airway compromise equipment failure

Breathing with oxygen therapy

patent airway established with continuous CCspine protection supplemental oxygen given - mask or catheter assist breathing if necessary bag & mask chest decompression if tension pneumothorax is suspected attach monitors pulse oximeter
Most fatal chest injuries

A T O M F C
Airway transection/rupture Tension pneumothorax Open pneumothorax Massive haemothorax Flail segment Cardiac tamponade

Indications for intubation and ventilation

Impending airway compromise Inadequate support from bag & mask Prolonged ventilation needed controlled ventilation needed
Trauma Assessment

C - circulation and haemorrhage control

level of consciousness colour, pulse,capillary refill , B.p look for obvious bleeding ensure patent intravenous(IV) access possible
largest
Pitfalls

poor correlation of b.p with cardiac output tachycardia in athletes occult bleeding

Circulation

control bleeding by direct pressure or operative intervention two good IV accesses + fluid therapy Consider inter-osseous needles if IV is difficult intercutcut-downs may be necessary take blood for baseline tests, GXM and BM monitor urinary output
Trauma Assessment

disability
A - Alert V - responds to Voice P - responds to Pain U - Unresponsive GCS may be used Pupils Posture haemorrhage or drugs lucid interval

Pitfalls

Trauma Assessment

E - Exposure and Environmental control

completely undress with minimal movement keep patient warm and decent
Pitfalls

massive infusion of cold fluids may worsen already existing hypothermia

Adjuncts to Primary survey & Resuscitation

Monitoring
vital signs arterial gases urinary output

X-rays (trauma series)

CXR Lateral C-spine C Pelvis


More Adjunts

Other diagnostic studies

Focused assessment sonography in trauma(FAST) Computerised tomography(CT) Diagnostic peritoneal lavage(DPL)

Gastric tube (nasal or oral) Urinary catheter
Trauma
Secondary Survey

head to toe assessment with due consideration to the already identified injuries But

primary survey must be completed resuscitative efforts must be well established and continued patient should be demonstrating normalisation of vital functions review ABC if any deterioration is noted during secondary survey
Trauma
Secondary Survey

History -AMPLE A - allergies M - medications P - past medical history L - last meal E - events/environment relating to injury
Trauma

History

Details about events and environment
Source

Vehicular accident Fall from height Assault including suicide(think NAI) Blunt Penetrating burns and cold
Type

other hazardous environment
Trauma
Secondary Survey

Examination

head and face Neck chest abdomen Perineum Back log roll Limbs Neurology
*Use as framework for recording notes
Trauma
Secondary Survey

Log roll

5 people must be a clear leader must give clear instructions
Note: May be done earlier to relieve pressure from spinal board
Trauma
Definitive care

Referral Safe transfer or retrieval
Summary

Simple concept of trauma management Sequence of assessment and resuscitation Essential initial imaging in trauma System of recording notes in trauma

Primary Survey

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Primary Survey

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Trauma Primary and Secondary Survey

Sarah Pearson Emergency Department Consultant Queens Hospital, Burton

Trauma Assessment & Resuscitation

Technically longitudinal progression of events In reality often parallel or simultaneous

Treat problems as they are found

don t ever forget glucose

A - airway and C-spine control C   

jaw thrust chin lift head tilt

ETT (oral or nasal)

OroOro-pharyngeal airway NasoNaso-pharyngeal airway

B- Breathing with oxygen therapy

airway compromise equipment failure

Breathing with oxygen therapy

Most fatal chest injuries

Indications for intubation and ventilation

C - circulation and haemorrhage control

E - Exposure and Environmental control

massive infusion of cold fluids may worsen already existing hypothermia

Adjuncts to Primary survey & Resuscitation

X-rays (trauma series)

Other diagnostic studies

Gastric tube (nasal or oral) Urinary catheter

Details about events and environment

other hazardous environment

*Use as framework for recording notes

5 people must be a clear leader must give clear instructions

Note: May be done earlier to relieve pressure from spinal board

Referral Safe transfer or retrieval

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A - airway and C-spine control C