PRIMARY SURVEY IN TRAUMA

PATIENTS
 INITIAL ASSESSMENT AND
MANAGEMENT
• ATLS principle guide the assessment and
resuscitation of injured patients.
• When treating injured patients, clinicians
rapidly assess injuries and institute life
preserving therapy.
• Because timing is crucial, a systematic
approach that can be rapidly and acuurately
applied is essential. This approach termed the
initial assessment
It includes
• Preparation
• Triage
• Primary survey
• Adjunts to primary survey
• Consideration of the need for patients transfer
• Secondary survey
• Adjuncts to secondary survey
• Continued postresuscitation monitoring and
reevaluation
• Defintive care
 PRIMARY SURVEY
• Primary survey includes ABCDs with
immediate resuscitation of patients with life
threatening injuries.
• A – Airway maintenance with restriction of
cervical spine motion
• B – Breathing and ventilation
• C – Circulation with haemorrhage control
• D – Disability (Assessment of neurological
status)
• E – Exposure/Environmental control
• Clinician can quickly assess ABCD in a trauma
patients ( 10 Seconds)
• Asking the patients for his or her name and what
happened
• Appropriate response suggest n major airway or
breathing compromise, GCS is adequate
• Failure to respond should warrant urgent
assessment and management
 AIRWAY MANAGEMENT

• Inspect for foreign bodies

• Identify facila/madibular/tracheal or laryngeal
fracture or other injuries that can result in
airway obstruction
• Suction
1.Initially jaw thrust/chin lift maneuvre
2. Oropharyngeal airway
• Secure definitive airway
• Compromised airway/desaturation/severe
head injury/low gcs(<8)-- > consider definitive
airway
• Secure cervical collar
• During airway management cervical collar is
opened and ask assistence to restrict motion
of the cervical spine.
• Establish an airway surgically if intubation is
contraindicated or cannot be accomplished
 BREATHING AND VENTILATION
• Ventilation requires adequate function of the
lungs, chest wall and diaphragm.
• O/E
- Jugular venous distension
- Position of the trachea
- Chest wall excursion
- Expose the patients neck and chest
• Perform ascultation for air entry
• Visual inspection and palpation to detect
injuries to the chest wall
• Percusiion
• Every injured patients should receive
supplement oxygen till the injuries are rulled
out
 CIRCULATION WITH HAEMORRHAGE
CONTROL
• SHOCK
• TYPES OF SHOCK
• ONCE THE TENSION PNEMOTHORAX HAS
BEEN EXCLUDED AS A CAUSE OF SHOCK
CONSIDER THAT HYPOTENSION FOLLOWING
INJURY IS DUE TO BLOOD LOSS UNTIL PROVEN
OTHERWISE
CLINICAL FEATURES OF SHOCK
 BLEEDING
• SOURCE
External or internal
• External haemorrhage controlled during
primary survey
• For rapid blood loss direct manual pressure on
the wound
• Tourniquets for extrimity injury
 INTERNAL HAEMORRHAGE
• Source : chest abdomen, retroperitoneum ,
pelvis , long bones
• Source identification
- Clinical examination
- Imaging
- FAST
- Diagnostic pertoneal lavage
• Immediate treatement
Chest decompression
Pelvic stabilization extrimity splints
Secure 2 large bore IV line if not accesible
Intraosseous
CVC
Venous cutdown
• Meanwhile withdraw blood for
• CBC
• Blood type and cross matching
• Pregnancy test
• ABG
• Administer IV fluid (warmed or administer
using fluid warming device)
• Blood and blood product
• Activate massive blood transfusion protocol if
necessary
• Administer Tranexamic acid
 DISABILITY
• Neurological assesssment
• Assess Level of conciousness
• GCS
• Determine spinal cord injury
• Brain injury
• Imaging , neurosurgery opinion
 EXPOSURE
• During the primary survey, completely undress
the patient by cutting garment to facilitate a
through examination and assessment.
• After the assessment cover the patients with
warm blanket or external warming device to
hypothermia
 ADJUVANTS TO THE PRIMARY SURVEY
WITH RESUSCITATION
• ECG
• Pulse oximetry
• ETCO2
• Monitor RR
• ABG
• Urinary catheter
• Gastric catheter
• Imaging
THANK YOU