Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Laboratory Findings + • 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 +++ Imaging Findings + • 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 + • Multiple injuries may be identified and should be addressed by the A-B-C (Airway-Breathing-Circulation) approach +++ Airway + • 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 +++ Breathing + • 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 +++ Circulation + • 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• ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth