INITIAL AND SECONDARY ASSESSMENT OF AN INJURED PATIENT

Multiply injured person is as patient who has injuries in two or more systems. They occur
in road traffic accidents, violent crime and fall more than 6 meters.
Assessment by trauma team is done in stages

1. Primary survey and Resuscitation

2. Secondary survey
3. Review, documentation and initial treatment plan

Danger- check for danger to yourself, your partner, bystanders and the patient

Response: - determine the level of consciousness use the AVPU scale

A- is the patient alert

V- response to verbal stimuli

P- response to pain stimuli

U- or unresponsive

I. PRIMARY SURVEY AND RESUSCITATION

It uses a mnemonic for the sequential management priorities of airway, breathing,

circulation, and disability (ABCD).

A- AIRWAY
Recognize any airway obstruction- suck out secretions, fallen tongue backward pulled out
and neck retracted.
Look out for possible cervical spine injury- motion restriction is maintained if injury is
suspected
Insert an endotracheal tube in unconscious patients and prevent any further obstruction

B- BREATHING

Ensure breathing occurs.

- Determine if the patient is spontaneously breathing.

- Assess skin color, chest rise and fall, and rate and depth of respirations.

- Assess soft tissue and bony chest wall integrity.

- Auscultate breath sounds.

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 - Apply supplemental oxygen

C- ASSESS CIRCULATION

Ensure there is satisfactory volume with the circulation and adequate cardiac output with
control of blood loss.

Assess pulse rate and character and obtain blood pressure

Capillary filling

Blood for group and x-match

In case of shock, run fluids- Initial blood loss should be replaced – Fluids initially later
blood transfusion.

Cardiopulmonary resuscitation (CPR) manually compression of the heart to restart the

heart if it stopped

Defibrillation, in case of open wounds of the chest bandage

D- ASSESS FOR DISABILITY.

Check neurological disability of the patient:-

a brief neurological examination, including and

Mental status and

Calculating the GCS score.

II. SECONDARY SURVEY

Comes after the primary survey is complete after all the life-threatening conditions are
removed. Expose the whole patient and do a head to toe examination quickly. Protect
against hypothermia by providing warmth.

 Head- ulceration, injuries, fractures, neurological deficits

 Thorax assessment- chest injuries

 Abdominal assessment- any visceral injuries- infection is likely

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  Assessment of extremities: Note any life threatening injuries
 Spine: - cervical spine is very important as well as spinal injury

Finally

Stabilize the patient and transfer to the ward give definitive management

a) Home management may follow

b) Rehabilitation.

All severely injured patients should be managed as follows

a) Airway is opened
b) Oxygen given immediately incase of hypoxemia
c) Intravenous line is established
d) Check for neurological deficit
e) Assess form head to toe for specific injuries
f) Monitor – urine output- insert a catheter