INITIAL ASSESSMENT OF THE TRAUMA PATIENT

The TRAUMA TEAM

Concepts of Initial Assessment
Rapid Primary Survey
Resuscitation
Detailed Secondary Survey
Re-evaluation
Initiate Definitive Care

Concepts of Initial Assessment
Triage
Sorting of Patients According to
ABCs and Available Resources

Concepts of Initial Assessment
Primary Survey
Adult / Pediatric priorities – Same
A - Airway with C-Spine Control
B - Breathing
C - Circulation With Hemorrhage Control
D - Disability: Neurologic Status
E - Exposure / Environment

Concepts of Initial Assessment
Primary Survey
Establish Airway
Caution
Cervical Spine Injury

Airway Management

Nasal Cannula or Catheter

Oxygen Mask

Mask with Reservoir Bag

Venturi Mask
FiO2 from 0.24 to 0.40

The Patient Condition
Conscious
Partially/ fully unconscious
A. Spontaneous respiration
1. Occluded/ obstructed
2. Inadequate
B. Apneic

Signs and Symptoms of Airway Obstruction
Noisy breathing
Effort of breathing: tracheal tugging, intercostal recession, abdominal see-saw movement
Increased use of respiratory muscles
Apnea (late)
Cyanosis (late)

Basic Management of Airway Obstruction
Chin lift and head tilt.
Jaw thrust.
Both maneuvers.
Oro/nasopharingeral airways.
Heimlich maneuver, suction etc.
Ventilation via mask and AMBU.

Head Tilt/ Chin Lift

Jaw Thrust

Heimlich Maneuver

Modes of ventilation
Mouth-to-mouse/ mouth-to-nose
Mouth-to-mask
Bag-valve device
Transtracheal jet-ventilation
Automatic transport ventilators

Indications for securing an airway with an Endotracheal tube
Apnea
Obstruction of upper airway
Protection of lower airway from soiling with blood or vomitus
Respiratory insufficiency
Impending of potential compromise of airway (prophylactic intubation)- for example, after facial burns
Raised intracranial pressure requiring hyperventilation

Definitive airway

The technique for rapid- sequence intubation is as follows:
1. Preoxygenate the patient with 100% oxygen
2. Apply pressure over the cricoid cartilage
3. Administer 1-2 mg/kg succinylcholine I.v.
4. After the patient relaxes, intubate the patient orotracheally
5. Inflate the cuff and confirm tube placement (auscultate the patient’s chest and determine of CO2 in exhaled air)
6. Release cricoid pressure
7.Ventilate the patient

Cricoid Pressure

“Sniffing Position”
Remember about C-spine protection!!!

Endotracheal Intubation

Endotracheal Intubation

Endotracheal Intubation

Endotracheal Intubation

Endotracheal Intubation

Alternatives to Endotracheal Intubation

Alternatives to Endotracheal Intubation
Oropharyngeal airway
Nasopharyngeal airway
Laryngeal mask airway
Esophageal-tracheal Combitube®
Crycothyrotomy
Tracheostomy

Laryngeal Mask Airway

LMA

Fast-track LMA®

Combitube®

Combitube®

Crycothyrotomy

Tracheostomy

Concepts of Initial Assessment
Primary Survey
Assume C-Spine Injury !!
Multi System Trauma
Altered Level of Conciousness
Blunt Injury Above Clavicles

Concepts of Initial Assessment
Primary Survey
Circulation
Assess Blood Volume Loss and Cardiac Output
Level of Cociousness
Skin Color
Pulse

Concepts of Initial Assessment
Primary Survey
Disability:
Neurological Evaluation
Level of Conciousness
A - Alert
V – Response To Voice
P - Response To Pain
U - Unresponsive
Pupils

Concepts of Initial Assessment
Primary Survey
Exposure / Environment
Undress Pt Completely
Protect from Hypothermia

Concepts of Initial Assessment
Resuscitation
Protect / Secure Airway
Ventilate / Oxygenate
Fluid Therapy – New concept ??!!
Protect from Hypothermia
Caution: Urinary / Gastric Catheters Unless Contraindicated

Concepts of Initial Assessment
Protect from Hypothermia

Initial Assessment
Catheter Contraindications

Initial Assessment
Monitor
Vital Signs
Urinary Output
ABGs
ECG, Temp, Pulse Oximetry
Ent\d Tidal CO2

Initial Assessment
Resuscitation
Manage Life-Threatening Injuries In Sequence and as Identified
Consider Need For Transfer: MD to MD communication

Initial Assessment
Before 2ry Survey
Complete 1ry Survey
Initiate Resuscitation
Reassess ABGs

Initial Assessment
Secondary Survey
Head-To-Toe Evaluation
Complete Neurologic Evaluation
X-Rays
Special Procedures (Angio, MRI)
“Tubes & Fingers in Every Orifice”
RE-EVALUATION

Initial Assessment
“TRAUMA X-Rays”
?

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Mobile X-Ray

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
A,B,C,D,E and U(ultra sound)

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Secondary Survey
Mechanism Of Injury: BLUNT
Direction of Impact Determines Injury Patterns
History / Description of Events
Age Factors

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Secondary Survey
Mechanism Of Injury: Penetrating
Anatomic Factors
Energy Transfer Factors
Velocity and Caliber of Bullet
Trajectory
Distance

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Spine X-Ray Issues

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Secondary Survey
Musculoskeletal
Extremities/Pelvis:
Contusions, Deformity, Pain, Crepitation, Abnormal Movement
Vascular:
Assess All Peripheral Pulses
Spine:
Physical Finding
Mechanism of Injuries

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Secondary Survey
Neurologic
Determine GCS Score
Re-Evaluate Pupils
Sensory / Motor Evaluation
Maintain Immobilization
Prevent 2ry CNS Injury
Early Neurosurgical Consultation

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Re-Evaluation
New Findings / Deterioration / Improvement
High Index Of Susspicion
Continuous Monitoring
Pain Relief AFTER Surgical Consultation

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
Definitive Care
Trauma Center Vs
Closest Appropriate Hospital

INITIAL ASSESSMENT of THE TRAUMA PATIENT
Initial Assessment
The Aftermath