Management of trauma can often be tricky, which is why a systematic approach to trauma is essential.
Assessment in trauma is divided into a primary, secondary and tertiary survey.
There are 5 main components of a primary survey:
AIRWAY AND C-SPINE CONTROL
Ensuring airway patency
C spine precautions
Basic airway manoeuvres +/- adjuncts
BREATHING AND VENTILATION
Look asymmetry, external bruising/bleeding
Signs of tension pneumothorax will need immediate needle decompression followed by formal ICC
CIRCULATION AND HAEMMORHAGE CONTROL - Assessing for Blood Loss in the following areas-
Thorax -Hemothorax / Large veesel injury
Abdomen - Solid or Hollow viscera
Pelvis - Veins, arteries
Fracture related blood
BP, HR, capillary refill
Bloods, IV access
Aim for minimal volume resuscitation
Identify areas of potential bleeding: chest, abdomen, retroperitoneum, pelvis, long bones and externally
Consider activating MTP
Early surgical intervention
Seek and treat hypoglycaemia
EXPOSURE AND ENVIRONMENTAL CONTROL
Expose patient to identify any potential life threatening injuries, being mindful to not cause hypothermia
The ABCDE approach should be used not just for trauma patients but for all patients to help identify and treat life threatening injuries early. It is essential to continuously reassess ABCs as a patient’s haemodynamic status can change.
The secondary survey is a top to toe examination that should be done once the primary survey is done and immediate life threats have been addressed.
Do not forget to take a short AMPLE history
A - Allergies
M - Medications
P - Past medical
L - Last Meal
Usually Trauma Screen includes
Usually a 'TRAUMA PANEL' includes
Coag / INR
Group and Hold
The tertiary survey is a repeat of the secondary survey, and aims to identify any potentially missed injuries. Also comprehensive review of all LABS, IMAGING and SPECIALIST opinions.
Emergency Medicine - Cadogan & Brown