• Primary survey to identify and treat immediate life-threatening conditions
• Identification of life-threatening injuries
• Response to treatment evaluated
• Primary evaluation includes:
• 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
• 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
• 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
• 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
• 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:
• 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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