Trauma approach |
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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. PRIMARY 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- ICH 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 FAST scan Early surgical intervention DISABILITY Check pupils Seek and treat hypoglycaemia Focal neurology Seizure treatment 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. SECONDARY SURVEY 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 IMAGING Usually Trauma Screen includes CXR C Spine Pelvis FAST Scan LABS Usually a 'TRAUMA PANEL' includes Vgas FBC UELFT Lipase BHcg Coag / INR Group and Hold TERTIARY SURVEY 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
Adult Trauma
Paediatric Trauma
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