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  • • Primary survey to identify and treat immediate life-threatening conditions

    • Identification of life-threatening injuries

    • Resuscitation

    • Response to treatment evaluated

    • Primary evaluation includes:

    • -Airway

      -Breathing

      -Circulation

      -Deficit

      -Exposure

    • Secondary survey evaluates for additional injuries

    • Rapid and complete history and physical exam are essential for patients with serious or multiple injuries

    • Progressive changes in clinical findings are often the key to correct diagnosis

    • Certain types of trauma should prompt directed evaluation for associated injuries

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Laboratory Findings

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  • • Blood should be immediately drawn for Hgb, WBC count, creatinine, blood urea nitrogen, and blood typing and cross-match

    • ABG measurement if any sign of respiratory compromise

    • Liver panel if any indication of liver disease

    • UA should be obtained, checking especially for hematuria

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Imaging Findings

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  • • Films of the chest and abdomen are required in all major injuries

    • Cervical spine films should be obtained in patients at risk for this kind of injury

    • CT scan of head and abdomen may be considered in patients with altered mental status and hemodynamic stability

    • Intravenous pyelogram is critical in abdominal injuries and pelvic fractures

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  • • Multiple injuries may be identified and should be addressed by the A-B-C (Airway-Breathing-Circulation) approach

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Airway

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  • • The establishment of an adequate airway has the highest priority in the primary survey

    • Cervical spine injury is always assumed until proved otherwise

    • Orotracheal intubation can be attempted if second person maintains in-line cervical stabilization

    • If necessary, cricothyroidotomy should be performed as quickly as possible

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Breathing

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  • • Ensure that ventilation is adequate; examine chest rise, breath sounds, tachypnea, crepitus, and subcutaneous emphysema, presence of open or penetrating wounds

    • Identify immediately life-threatening conditions:

    • -Tension pneumothorax

      -Open pneumothorax

      -Massive hemothorax

      -Flail chest

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Circulation

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  • • Gross hemorrhage from accessible surface wounds is usually obvious and can most often be controlled with direct pressure and elevation

    • Firm pressure on the major arteries in the axilla, groin, antecubital space, wrist, popliteal space, or ankle may suffice for temporary control of arterial hemorrhage distal to these points

    • When other measures have failed, a tourniquet may rarely be necessary to control major hemorrhage from an extremity

    • Tourniquets must be released for 1-2 minutes every 20 minutes until definitive care is provided

    • All patients with significant trauma should have 2 large caliber IV catheters inserted immediately for the administration of drugs and fluids

    • If any degree of shock present, a large bore venous catheter should be placed in the femoral vein to monitor central venous pressure (CVP)

    • As soon as IV access is gained, rapid crystalloid infusion should begin

    • Adults should receive 2 L of normal saline or lactated Ringer's with an additional 2 L given for transient or no response

    • For children, 20 mL/kg should ...

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