Overview
1. Preparation
2. Triage
3. Primary Survey
4. Resuscitation
5. Secondary Survey
6. Continued postresuscitation
monitoring and re-evaluation
7. Definitive care
Preparation
Prehospital
Inhospital
Warmed IV solutions
Ancillary departments notified
Equipment made readily available
Primary Survey
Airway
Breathing
Circulation
Disability: Neurologic
Evaluation
Exposure/Environmental Control
Primary Survey
Airway
Patency
Foreign bodies
Facial Fractures
Protect C-spine
Primary Survey
Breathing
Massive hemothorax
Flail chest
Rib fractures
Open pneumo
Pulmonary contusion
Primary Survey
Circulation
Hemorrhage control
Two Key Elements
1. Level of Consciousness
-AVPU
-Glasgow Coma Score
2. Pulse
Bleeding
Control
No hemostats
Consider occult sources
Primary Survey
Disability
AVPU
Glasgow Coma
Verbal Response
Oriented
6
Confused
Inappropriate words
Incomprehensible sounds
None
1
Eye Opening
Spontaneous
To speech
To pain
None
4
3
2
1
Motor response
5
4
3
2
1
Obeys
Localizes
Withdraws
4
Decortication
3
Decerebration
None
Primary Survey
Exposure
Remove all clothes
Cover to prevent hypothermia
Resuscitation
Airway
Oral
Nasal- do not put in someone with
facial
trauma
Endotracheal
Surgical
Breathing
Supply O2
Ventilate alveoli
Resuscitation
Circulation
Hemorrhage classification
Class
% blood
loss
10 19
(750 cc)
Heart rate
Blood
pressure
II
20 29
(1250)
>100
Slightly
III
30 39
(2000)
>120
IV
>40
>140
Pulse
pressure
Resp rate
Capillary
refill
Normal
Urine
output
Other
Mortality
Oliguria
Acidosis
25%
Delayed
(>30)
Very
Delayed
Anuria
60%
Resuscitation
Catheters
Urinary
Rectal first
Check for other signs of urethral
injury
Gastric
NGT Intracranial
Resuscitation
Monitoring
ABGs
Pulse oximetery
Blood pressure
ECG
Roentgenograms
Other Imaging
FAST scan
Focused Assessment Sonography in Trauma
Ultrasound
1. Pericardial sac (epigastric area)
2. Hepatorenal fossa
3. Splenorenal fossa
4. Pelvis or Pouch of Douglas (bladder)
Secondary Survey
Head-to toe evaluation
Vital sign evaluation
Detailed neuro exam if not
done in primary survey
Special procedures
Secondary Survey
History
A Allergies
M Medications
P Past illnesses
L Last meal
E Events related to injury
1.Blunt
2.Penetrating
3.Burns
4.Hazardous Environment
Secondary Survey
History
A Allergies
M Medications
P Past illnesses
L Last meal
E Events related to injury
1.Blunt
2.Penetrating
3.Burns
4.Hazardous Environment
Scalp
Eyes
Nose
Mouth
Bite occlusion
Midface Fractures
LaFort
I: Maxilla only transversely above the
alveolar ridge
Most common isolated
Must be immobilized
Inspection
Palpation
Auscultation (carotids)
Pneumothorax
Tension Pneumothorax
Pancreatic injury
Major intraabdominal vascular injury
Renal injury
Pelvic fractures
Contusions,Hematomas, Lacerations
Urethral bleeding
Rectal blood
High riding prostate
Sphincter tone
Vaginal vault injuries (pelvic
fractures)
Retrograde urethrogram
Contusion
Deformity
Palpation
Pelvic pressure and compression
Vascular exam
Neurologic exam
Subdural Hematoma
Epidural Hematoma
Aftercare
Continuous reevaluation
Definitive care