This document outlines the initial assessment and management of trauma patients. It discusses:
1) Preparation for patient care including triage to prioritize patients.
2) The primary survey which follows the ABCDE approach to assess the airway, breathing, circulation, disability, and exposure. Resuscitation also follows the ABCs.
3) Adjuncts that can provide additional information during the primary survey like monitoring, imaging and labs.
4) The secondary survey which is a full physical exam and history to identify all injuries. Continuous reevaluation is also important to detect new findings.
This document outlines the initial assessment and management of trauma patients. It discusses:
1) Preparation for patient care including triage to prioritize patients.
2) The primary survey which follows the ABCDE approach to assess the airway, breathing, circulation, disability, and exposure. Resuscitation also follows the ABCs.
3) Adjuncts that can provide additional information during the primary survey like monitoring, imaging and labs.
4) The secondary survey which is a full physical exam and history to identify all injuries. Continuous reevaluation is also important to detect new findings.
This document outlines the initial assessment and management of trauma patients. It discusses:
1) Preparation for patient care including triage to prioritize patients.
2) The primary survey which follows the ABCDE approach to assess the airway, breathing, circulation, disability, and exposure. Resuscitation also follows the ABCs.
3) Adjuncts that can provide additional information during the primary survey like monitoring, imaging and labs.
4) The secondary survey which is a full physical exam and history to identify all injuries. Continuous reevaluation is also important to detect new findings.
This document outlines the initial assessment and management of trauma patients. It discusses:
1) Preparation for patient care including triage to prioritize patients.
2) The primary survey which follows the ABCDE approach to assess the airway, breathing, circulation, disability, and exposure. Resuscitation also follows the ABCs.
3) Adjuncts that can provide additional information during the primary survey like monitoring, imaging and labs.
4) The secondary survey which is a full physical exam and history to identify all injuries. Continuous reevaluation is also important to detect new findings.
Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1/ 21
Initial Assessment
and Management INITIAL ASSESSMENT
Preparation
Triage
Primary survey (ABCDEs)
Resuscitation
Adjuncts to primary survey and
resuscitation Consideration of the need for patient transfer Secondary survey (head-to-toe evaluation and patient history)
Adjuncts to the secondary survey
Continued postresuscitation monitoring and Reevaluation
Definitive care PREPARATION
PREHOSPITAL PHASE
Airway maintenance, control of external bleeding and shock,
immobilization of the patient, and immediate transport to the closest appropriate facility
HOSPITAL PHASE TRIAGE
Triage involves the sorting of patients based on their needs for treatment and the resources available to provide that treatment
In multiple-casualty incidents, although there is more than one patient, the
number of patients and the se- verity of their injuries do not exceed the capability of the facility to render care. In such situations, patients with life- threatening problems and those sustaining multiple-system injuries are treated first.
In mass-casualty events, the patients having the greatest chance of survival and requiring the least expenditure of time, equipment, supplies, and personnel, are treated first. PRIMARY SURVEY
Airway maintenance with cervical spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability: Neurologic status
Exposure/Environmental control: Completely
undress the patient, but prevent hypothermia PRIMARY SURVEY AIRWAY MAINTENANCE WITH CERVICAL SPINE PROTECTION
Initial evaluation of a trauma patient, the airway should be assessed first
to ascertain patency
The patient’s head and neck should not be hyperextended, hyperflexed,
or rotated to establish and maintain the airway. Based on the history of a traumatic incident, loss of stability of the cervical spine should be assumed. Neurologic examination alone does not exclude a diagnosis of cervical spine injury.
Patients with severe head injuries who have an altered level of
consciousness or a Glasgow Coma Scale (GCS) score of 8 or less usually require the placement of a definitive airway (i.e., cuffed, secured tube in the trachea). The finding of nonpurposeful motor responses strongly suggests the need for defini- tive airway management. PRIMARY SURVEY Breathing and ventilation
Airway patency alone does not ensure adequate
ventilation
Ventilation requires adequate function of the lungs, chest
wall, and diaphragm
The patient’s neck and chest should be exposed to
adequately assess jugular venous distention, position of the trachea, and chest wall excursion.
Injuries that severely impair ventilation in the short term
include tension pneumothorax, flail chest with pulmonary contusion, massive hemothorax, and open pneumothorax. PRIMARY SURVEY CIRCULATION WITH HEMORRHAGE CONTROL
Hemorrhage is the predominant cause of preventable
deaths after injury.
The elements of clinical observation that yield important
information within seconds are level of consciousness, skin color, and pulse
The source of bleeding should be identified as either
external or internal PRIMARY SURVEY
DISABILITY (NEUROLOGIC EVALUATION)
A rapid neurologic evaluation is performed at the end of
the primary survey. This neurologic evaluation es- tablishes the patient’s level of consciousness, pupillary size and reaction, lateralizing signs, and spinal cord injury level.
A decrease in the level of consciousness may indicate
decreased cerebral oxygenation and/or perfusion, or it may be caused by direct cerebral injury PRIMARY SURVEY EXPOSURE AND ENVIRONMENTAL CONTROL
Intravenous fluids should be warmed before being infused, and a warm
environment (i.e., room temperature) should be maintained. The patient’s body temperature is more important than the comfort of the healthcare providers. Resuscitation
Resuscitation also follows the ABC sequence and occurs simultaneously
with evaluation.
AIRWAY
• The jaw-thrust or chin-lift maneuver may suffice as an initial intervention. If the patient is unconscious and has no gag reflex, the establishment of an oropharyngeal air- way can be helpful temporarily. A defnitive airway (i.e., intubation) should be established if there is any doubt about the patient’s ability to maintain airway integrity.
BREATHING, VENTILATION, AND OXYGENATION
• Every injured patient should receive supplemental oxygen
CIRCULATION AND HEMORRHAGE CONTROL
• De nitive bleeding control is essential along with appropriate replacement of intravascular
volume. • Aggressive and continued volume resuscitation is not a substitute for definitive control of hemorrhage. Adjuncts to Primary Survey and Resuscitation
ELECTROCARDIOGRAPHIC MONITORING • Dysrhythmias—including unex- plained tachycardia, atrial fibrillation, premature ven- tricular contractions, and ST segment changes—can indicate blunt cardiac injury URINARY AND GASTRIC CATHETERS • Urinary output is a sensitive indicator of the patient’s volume status and reflects renal perfusion.
Ventilatory Rate and Arterial Blood Gases
• Ventilatory rate and ABG levels should be used to monitor the adequacy of respirations.
Pulse Oximetry • The pulse oximeter measures the oxygen saturation of hemoglobin colori- metrically, but it does not measure the partial pres- sure of oxygen. It also does not measure the partial pressure of carbon dioxide, which reflects the adequacy of ventilation.
Blood Pressure
X-RAY EXAMINATIONS AND DIAGNOSTIC STUDIES
CONSIDER NEED FOR PATIENT TRANSFER
During the primary survey and resuscitation phase, the evaluating physician frequently obtains enough information to indicate the need to transfer the pa- tient to another facility SECONDARY SURVEY
The secondary survey does not begin until the primary survey (ABCDEs) is completed, resuscitative e orts are underway, and the normalization of vital functions has been demonstrated
The secondary survey is a head-to-toe evalua- tion of the trauma patient, that is, a complete history and physical examination, including reassessment of all vital signs.
The AMPLE history is a useful mnemonic for this purpose:Allergies, Medications
currently used, Past illnesses/Pregnancy, Last meal, Events/Environment related to the injury
The patient’s condition is greatly influenced by the mechanism of injury, and some injuries can be predicted based on the direction and amount of energy behind the mechanism of injury ( Blunt Trauma, penetrating truma, thermal injury, Hazardous Environment ) Adjuncts to the Secondary Survey
Missed injuries can be minimized by maintaining a high index of
suspicion and providing continuous monitoring of the patient’s status. Specialized diagnostic tests may be performed during the secondary survey to identify specific injuries. Reevaluation
Trauma patients must be reevaluated constantly to ensure that
new findings are not overlooked and to discover deterioration in previously noted findings. As initial life threatening injuries are managed, other equally life threatening problems and less severe injuries may become apparent THANK YOU
