hg

Others

Emergency Department

Major Trauma

ACUTE MAYOR TRAUMA ALGORITHM- PRIMARY SURVEY

 

 

  • Approach the patient from the side confirming that its safe to approach- shout for help.

 

 

1. AIRWAY + C-SPINE:

  • Stand behind patient with your hands stabilizing the head (fingers apart so that they don’t cover the ears).

  • Confirm who is your assistant and ask them to get you a c-spine head brace

  • Inspection: airway obstruction- foreign bodies, facial, mandibular, tracheal, laryngeal fractures

  • Put your cheek to their mouth and feel for any air movement.

  • Interventions: if not breathing do a jaw thrust (will need both hands)

  • Suction: to clear the airway of FB.

  • Establish a definitive airway: orotracheal or nasotracheal intubation, jet insufflation, surgical cricothyroidotomy.

  • Ask assistant for high flow oxygen: 15 litres/min through non- rebreathing (Hudson) mask (provides ~ 85% oxygen).

 

 

Indications for definitive airway:

Unconscious (GCS ≤ 8)

Severe maxillofacial fractures

Risk of aspiration (bleeding, vomiting)

Risk of obstruction

 

 

 

2. BREATHING + VENTILATION:

  • Inspection: chest wall movement (symmetrical), chest injuries

  • Palpation: bony deformities, fractured ribs, wounds

  • Interventions: pulse oximeter

  • Needle decompression (2nd intercostal space MCL)

  • Chest drain (5th intercostal space mid axillary line)

  • Seal open pneumothorax

 

 

Breathing problems identified in 1° survey:

Tension pneumothorax

Flail chest with pulmonary contusion

Massive hemothorax

Open pneumothorax

 

 

3. CIRCULATION + HAEMORRHAGE CONTROL:

  • Level of consciouness, skin colour, pulse

  • Inspection: colour (well perfused or pale), obvious haemorrhage

  • Palpation: feel hands (warm or cold), capillary refill time

  • Identify external bleeding- strongly palpate chest, abdomen, pelvis, long bones for haemorrhage

  • Presence of pulses: carotid (SBP≥ 60 mmHg), femoral (SBP≥ 70 mmHg) and radial (SBP≥ 80 mmHg)

  • Interventions: IV access- 2 litres Hartmanns for adult- BBC2- brown cannulae in both arms wherever you can get them. Take blood when put cannulae in for FBC, glucose. Blood transfusion

  • Surgical intervention for internal bleeding

  • Venous cutdown

  • Chest drain: for massive hemothorax

  • Pericardiocentesis: for cardiac tamponade

  • Blood pressure, ECG

 

 

Injuries that acutely impair circulatory status:

External/internal bleeding with hypovolemic shock

Massive hemothorax

Cardiac tamponade

 

 

4. DISABILITY + DIABETES:

  • GCS, AVPU for medical school

  • Pupils: size, equality and reaction

  • Blood glucose: pinprick for portable blood glucose monitor

  • Interventions: burr holes (for trans-tentorial herniation), IV mannitol

 

 

5. EXPOSURE + ENVIRONMENT:

  • Completely undressed the patient- prevent hypothermia- injured patients may arrive in hypothermic condition

  • Log-roll and warmed crystalloid fluid

 

 

6. ADJUNCTS TO PRIMARY SURVEY:

  • AP Chest and AP pelvic radiographs

  • Urinary Catheter

  • Gastric Catheter

  • ABG

  • DPL (Diagnostic peritoneal lavage) and FAST (Abdominal ultrasonography)

  • Analgesia: morphine 10mg in 10ml after you have completed A-C

 

 

Author: Johno Breeze

Last updated: 15/02/2015