Initial assessment and management of a trauma patient (core) | Mechanism? Penetrating vs blunt Primary survey—ABCDE—the starting point for every trauma patient Airway—Confirm patent airway - Early intubation in patients with unstable airway - If unable to establish an orotracheal or nasotracheal airway, perform a cricothyroidotomy Breathing—Confirm presence of bilateral, equal, breath sounds Circulation—Evaluate central pulses, BP, and HR - Ensure patient has appropriate access for resuscitation - Start initial resuscitation for hypotension, if indicated - Gain temporary hemorrhage control with manual compression, packing, or tourniquet, if needed Disability—Calculate GCS, evaluate for neuro deficits, maintain spine immobilization Exposure—Remove all clothing so that entire body can be evaluated Adjuncts to primary survey: If at any time you do an intervention during the primary survey (ie, place chest tube, intubate patient, etc), restart the primary survey from the top Secondary exam—once primary survey complete and any immediately life-threatening issues are dealt with, do a full head-to-toe exam, including rolling the patient, to make a full inventory of the patient’s injuries | Trauma labs: CBC, CMP, lipase/amylase, ABG, lactate, type and screen, coagulants, UDS Adjuncts to primary survey: CXR, pelvic XR, FAST Stable patients often go for a “trauma pan scan” which includes: - Noncontrast head CT - Noncontrast cervical spine CT - Chest CT with contrast (arterial phase) - Abdomen and pelvis CT with contrast (portal venous phase) You must be effective in identifying and treating these life-threatening diagnoses: |