⓿ PPE (goggles, mask, gown, and gloves)
- Ask if it’s safe to approach the pt?
❶ AIRWAY + C-SPINE:
- Stabilize C-spine manually
- Talk to the pt (patent airway, conscious pt, in pain?)
- Any maxillo-facial fracture?
- Ask the pt to open their mouth (inspect for foreign bodies)
- Look, listen, and feel (closer assessment, stridor, hoarseness?)
- Oxygen mask
- Apply C-collar
- If signs of obstruction: (unable to talk, unconscious, stridor\hoarseness)
- Chin lift, jaw thrust
- Oropharyngeal airway
- Definitive airway
❷ BREATHING:
- Pulse oximetry
- Inspect the neck (distended neck veins, subcutaneous emphysema)
- Palpate trachea
- Expose chest
- Inspect chest (obv injuries, symmetrical breathing, respiratory rate)
- Palpate chest (crepitus, blood on gloves)
- Percuss chest
- Auscultate chest (breath sounds, heart sounds)
- Order a CXR + pelvic X-ray
- If tension pneumothorax –> needle decompression (2nd intercostal space, mid-clavicular line, listen, and fix it in place) + followed by chest tube
- If simple pneumothorax or hemothorax -> chest tube (5th intercostal space, ant\mid axillary line)
RE-ASSESS!
- Re-assessment is done via:
- Talking to the pt
- Checking oxygen saturation, HR, RR
❸ CIRCULATION:
- What’s the pt’s appearance?
- Check pulse + BP + capillary refill
- Insert 2 large-bore IV cannula in antecubital fossa (if fractured arm; go w\ femoral or central (jugular\subclavian)
- Draw blood for CBC, cross match, coagulation, chemistry, LFT, amylase, glucose, pregnancy test, toxicology
- Run warmed fluids through them (RL is the preferred fluid of choice in trauma)
- Any source of active\external bleeding?
- Examine limbs (deformity, abnormal swelling)
- Examine abdomen (distension, tenderness, bruising)
- Examine pelvis (fractured, stable)
- FAST
- If tachycardic, hypotensive -> pt is in shock -> order 4 U of cross-matched blood + 2 U of O neg
- If active\external bleeding -> apply direct pressure, pressure dressing, tourniquet
- If pelvic fracture -> apply pelvic splints\binders
RE-ASSESS!
❹ DISABILITY:
- Pupils
- GCS
RE-ASSESS!
❺ EXPOSURE:
- Check temperature
- Remove clothes and expose pt fully
- Cover pt w\ blankets
❻ LOG ROLL + PR EXAM
ADJUNCTS: (in addition to the ones mentioned above = highlighted in blue)
- ECG
- ABGs
- Decompression:
- Gastric -> NGT
- Urinary -> Foley’s cath
Download the PDF version: here
*Check Oxford’s trauma vids on youtube, this summary follows the same steps