Trauma Evaluation

• • 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

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