Primary Survey

⓿ PPE (goggles, mask, gown, and gloves)

• Ask if it’s safe to approach the pt?

❶ AIRWAY + C-SPINE:

1. Stabilize C-spine manually
2. Talk to the pt (patent airway, conscious pt, in pain?)
3. Any maxillo-facial fracture?
4. Ask the pt to open their mouth (inspect for foreign bodies)
5. Look, listen, and feel (closer assessment, stridor, hoarseness?)
6. Oxygen mask
7. Apply C-collar

• If signs of obstruction: (unable to talk, unconscious, stridor\hoarseness)
  • Chin lift, jaw thrust
  • Oropharyngeal airway
  • Definitive airway

❷ BREATHING:

1. Pulse oximetry
2. Inspect the neck (distended neck veins, subcutaneous emphysema)
3. Palpate trachea 
4. Expose chest
5. Inspect chest (obv injuries, symmetrical breathing, respiratory rate)
6. Palpate chest (crepitus, blood on gloves)
7. Percuss chest
8. Auscultate chest (breath sounds, heart sounds)
9. Order a CXR + pelvic X-ray

• If tension pneumothorax –> needle decompression (2^nd intercostal space, mid-clavicular line, listen, and fix it in place) + followed by chest tube
• If simple pneumothorax or hemothorax -> chest tube (5^th intercostal space, ant\mid axillary line)

RE-ASSESS!

• Re-assessment is done via:
  • Talking to the pt
  • Checking oxygen saturation, HR, RR

❸ CIRCULATION:

1. What’s the pt’s appearance?
2. Check pulse + BP + capillary refill
3. 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)
4. Any source of active\external bleeding?
5. Examine limbs (deformity, abnormal swelling)
6. Examine abdomen (distension, tenderness, bruising)
7. Examine pelvis (fractured, stable)
8. 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:

1. Pupils
2. GCS

RE-ASSESS!

❺ EXPOSURE:

1. Check temperature
2. Remove clothes and expose pt fully
3. 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

 

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Download the PDF version: here

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*Check Oxford’s trauma vids on youtube, this summary follows the same steps