Initial Assessment and Management

Presented byAbdulgadir F. Bugdadi

Objective

To have a quick overview of the principles of primary and secondary survey.

Preparation

Triage

Primary Survey

Resuscitation

Secondary Survey

Reevaluation

Definitive Care

Adjuncts to primary survey and

resuscitation

Consider need for patient

transfer

Adjuncts to secondary

survey

PRIMARY SURVEY

• What is the quickest way to assess the patient in 10 seconds ?

• A = Airway maintenance with cervical spine protection.• B = Breathing and ventilation.• C = Circulation with hemorrhage control.• D = Disability “Neurologic status”.• E = Exposure/Enviromental control.

Airway with Cervical Spine protection

• Ascertain patency

• Care to prevent excessive movement of cervical spine.

• Equally important to recognize the potential for progressive airway loss.

Breathing and ventilation

• Airway patency does not ensure adequate ventilation.

• Examination.

• Injuries that can impair ventilation in the short term …

Circulation with hemorrhage control

• Circulation issues to consider include :1. Blood volume.2. Cardiac output.3. Bleeding.

• Hypotension following injury; hypovolemic.

• Elements of clinical observation :1. Level of consciousness.2. Skin color.3. Pulse (Pitfalls). Pitfalls:

1. Elderly.2. Children.3. athletes.

Disability (Neurologic evaluation)

• evaluation composed of :1. Level of consciousness (GCS score).2. Pupillary size and reaction.

Exposure / Enviromental Control

• Completely undress the patient.

• Cover the patient following examination.

RESUSCITATION

Usually done simultaneously with primary survey as

“Aggressive resuscitation of life threatening injuries as they are found are essential to

maximize patient survival”

● Protect and secure airway (Jaw thrust, OPA….).

● Ventilate and oxygenate.

● Stop the bleeding!.

● Vigorous shock therapy (2 large bore IV. Catheter).

● Protect from hypothermia.

ADJUNCTS TO PRIMARY SURVEY AND

RESUSCITATION

• Electrocardiographic monitoring…• Urinary catheter… (Contraindications)

• Gastric catheter…• Pulse oximetry.• Ventilatory rate / ABG.• Blood pressure monitor.• X- ray examination and diagnostic studies (FAST / DPL)…

CONSIDER NEED FOR PATIENT TRANSFER

• Which patient need transfer?

• Don’t delay transfer for diagnostic tests.

Once decision to transfer the patient has been made, communication between the referring and receiving doctor is essential.

SECONDARY SURVEY

• When ? …

• Head-to-toe evaluation of the trauma patient (History and physical examination) + Reevaluation of the vital signs.

• Complete patient evaluation require repeated physical examination.

History

• AMPLE history.

• Blunt trauma, penetrating trauma and thermal injury history.

Examination

• Head :1. Laceration.2. Contusions.3. Fractures.

• Eyes :1. Visual acuity.2. Pupillary size.3. Hemorrhage of the conjunctiva or fundi.4. Penetrating injury.5. Contact lenses.6. Dislocation of the lense.7. Ocular entrapment

• Maxillofacial structures.

• Cervical spine and neck :1. Inspection …2. Palpation …3. Auscultation …

• Chest :1. Inspection …2. Palpation …3. Auscultation …

• Abdomen :Exam. FAST, DPL or CT scan.

• Perineum / Rectum / Vagina :contusions, hematomas, lacerations ,rectal and vaginal examination.

• Musculoskeletal system :Inspection and palpation. (don’t forget the back).hand, wrist, feet fractures may not be diagnosed in 2ndry survey.(frequent reevaluation)

• Neurologic :1. Motor and sensory evaluation.2. GCS score.3. Lateralizing signs.4. Spinal cord injury level.

ADJUNCTS TO SECONDARY SURVEY

• Specialized diagnostic tests may be performed to identify specific injuries.

• Patient must be hemodynamically stable.

REEVALUATION

• To ensure new findings are not overlooked.

• Detect deterioration in a previously noted findings.

DEFINITIVE CARE

Preparation

Triage

Primary Survey

Resuscitation

Secondary Survey

Reevaluation

Definitive Care

Adjuncts to primary survey and

resuscitation

Consider need for patient

transfer

Adjuncts to secondary

survey

SUMMERY

END---

Thank youReference ;