Professional Documents
Culture Documents
and
Management
© ACS
Objectives
© ACS
Concepts of Initial Assessment
Rapid Primary survey
Resuscitation
Adjuncts to primary survey /resuscitation
Detailed secondary survey
Adjuncts to secondary survey
Reevaluation
Definitive care
© ACS
© ACS
Initial Assessment
Prehospital System
Transport guidelines /protocols
On-line medical direction
Mobilization of resources
Periodic review of care
Closest appropriate facility
© ACS
Preparation
Inhospital
Preplanning essential
Equipment, personnel, services
Standard precautions
Transfer agreement
© ACS
Standard Precautions
• Cap
• Gown
• Gloves
• Mask
• Shoe covers
• Goggles/face
• Shields
© ACS
Triage
Sorting of patients according to :
• ABCDEs
• Available resources
Multiple casualties
Mass casualties
© ACS
Primary Survey
Adult, children, pregnant women –
Priorities are the same !
A Airway with c-spine protection
B Breathing
C Circulation with hemorrhage control
D Disability
E Exposure/Environment
© ACS
Special Considerations
↓Physiologic reserve
Comorbidities : Diseases/medications
care
© ACS
Primary Survey
Establish Patent Airway
C-spine injury
Pitfalls
• Equipment failure
Caution • Inability to intubate
• Occult airway injury
• Progressive loss of airway
© ACS
Primary Survey
© ACS
Primary Survey
Breathing
Assess
Oxygenate
Ventilate
Pitfalls
• Airway vs ventilation problem ?
• Latrogenic pneumothorax /tension
pneumothorax
© ACS
Primary Survey
Assessment of Organ Perfusion
Level of consciousness
© ACS
Primary Survey
Circulatory Management
Control hemorrhage
Restore volume
Reassess
Pitfalls
Elderly Children
Caution Athletes Medication
© ACS
Primary Survey
Disability
Baseline neurologic evaluation
• GCS scoring
• Pupillary response
© ACS
Primary Survey
Exposure / Environment
• Completely undress the patient
Prevent hypothermia
Caution
© ACS
Resuscitation
Protect and secure airway
Ventilate and oxygenate
© ACS
Adjuncts to Primary Survey
Vital sign
ECG ABGs
Urinary/gastric catheters
unless contraindicated
© ACS
Adjuncts to Primary Survey
Diagnostic Tools
• Chest and pelvic
x-ray
• DPL
• Ultrasound
© ACS
Adjuncts to Primary Survey
resuscitation
© ACS
Reevaluate
Proceed to Secondary Survey After :
Primary survey completed
ABCD Es are reassessed
normal
© ACS
Secondary Survey
The complete
history and
physical
examination
© ACS
Secondary Survey
Key Components
History
Reevaluation
© ACS
Secondary Survey
History
A Allergies
M Medications
P Past Illnesses
L Last meal
E Events/Environment
© ACS
Secondary Survey
Mechanisms of Injury
© ACS
Secondary Survey
Head
Complete neurologic examination
Pitfalls
Unconscious patient
Periorbital edema
© ACS
Secondary Survey
Maxillofacial
Bony crepitus/stability
Palpable deformity
Pitfalls
• Potential airway obstruction
• Cribriform plate fracture
• Frequently missed injury
© ACS
Secondary Survey
Cervical Spine
Palpate for Pitfalls
tenderness • Altered LOC for
Complete motor/ any reason
sensory exams • Other severe ,
Reflexes painful injury
C-spine imaging
© ACS
Secondary Survey
Neck (soft tissues)
Mechanism : Blunt Pitfalls
vs penetrating
• Delayed symptoms
Symptoms : Airway
© ACS
Secondary Survey
Chest
Pitfalls
Inspect
• Elderly
Palpate
• Children
Percuss
Auscultate
X-ray
© ACS
Secondary Survey
Abdominal Evaluation
© ACS
Secondary Survey
Abdomen
Inspect, auscultate, palpate, and percuss
Reevaluate frequently
Special studies
Pitfalls
© ACS
Secondary Survey
Perineum Contusions, hematomas,
lacerations, urethral blood
Blood lacerations
Vagina
Urethral injury in women,
pregnancy
Pitfalls
© ACS
Secondary Survey
Musculoskeletal : Extreminities
Contusion , deformity
Pain
Perfusion
X- rays as needed
© ACS
Secondary Survey
Musculoskeletal : Pelvis
Pain on palpation
Symphysis width ↑
Instability
X-rays as needed
© ACS
Secondary Survey
Musculoskeletal
Pitfalls
© ACS
Secondary Survey
Neurologic
Spine / Cord CNS
Complete motor Frequent reevaluation
Imaging as injury
indicated
Reflexes
© ACS
Secondary Survey
Neurologic
Pitfalls
• Incomplete immobilization
• Suble ↑ in ICP with manipulation
• Rapid deterioration
© ACS
Reevaluation
© ACS
Reevaluation
Pain Management
Relief of pain /anxiety as appropriate
Administer intravenously
© ACS
Definitive Care
Local Facility
??
Transfer agreements
?? Local resources ??
??
Trauma Specialty
Center Facility
© ACS
Record , Legal Considerations
Concise, chronologic documentation
Consent for treatment
Forensic evidence
© ACS
Summary
Primary Survey
Resuscitation
Adjuncts
• Secondary Survey
Adjuncts
• Definitive care
© ACS