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Primary Survey

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Caroline Chau

This document provides guidance on conducting primary and secondary surveys for trauma patients. The primary survey focuses on assessing the airway, breathing, circulation, disability, and exposure. Vital signs and a brief history are also obtained. The secondary survey involves a more thorough head-to-toe examination to identify and treat injuries. Key steps include inspecting, palpating, and auscultating different body regions like the head, neck, chest, abdomen, and limbs. Guidance is also given on estimating weight in children and selecting appropriate endotracheal tube sizes.

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Primary Survey

Uploaded by

Caroline Chau
158 views19 pages
This document provides guidance on conducting primary and secondary surveys for trauma patients. The primary survey focuses on assessing the airway, breathing, circulation, disability, and exposure. Vital signs and a brief history are also obtained. The secondary survey involves a more thorough head-to-toe examination to identify and treat injuries. Key steps include inspecting, palpating, and auscultating different body regions like the head, neck, chest, abdomen, and limbs. Guidance is also given on estimating weight in children and selecting appropriate endotracheal tube sizes.

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This document provides guidance on conducting primary and secondary surveys for trauma patients. The primary survey focuses on assessing the airway, breathing, circulation, disability, and exposure. Vital signs and a brief history are also obtained. The secondary survey involves a more thorough head-to-toe examination to identify and treat injuries. Key steps include inspecting, palpating, and auscultating different body regions like the head, neck, chest, abdomen, and limbs. Guidance is also given on estimating weight in children and selecting appropriate endotracheal tube sizes.

Copyright:

Attribution Non-Commercial (BY-NC)
Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
158 views19 pages

Primary Survey

Uploaded by

Caroline Chau
This document provides guidance on conducting primary and secondary surveys for trauma patients. The primary survey focuses on assessing the airway, breathing, circulation, disability, and exposure. Vital signs and a brief history are also obtained. The secondary survey involves a more thorough head-to-toe examination to identify and treat injuries. Key steps include inspecting, palpating, and auscultating different body regions like the head, neck, chest, abdomen, and limbs. Guidance is also given on estimating weight in children and selecting appropriate endotracheal tube sizes.

Copyright:

Attribution Non-Commercial (BY-NC)
Download as PPTX, PDF, TXT or read online from Scribd
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Assessment of Trauma Patients

Primary & Secondary Surveys


Caroline CHAU

AIRWAY + C-SPINE IMMOBILISATION


Check airway patency
Suction Remove foreign bodies/vomitusetc

Chin lift Jaw thrust Oropharyngeal airway Consider intubation Facial trauma precluding orotracheal intubation Sx airway
Cricothyroidotomy Emergent tracheostomy

Look Listen Feel Check for:


Symmetry Effectiveness
Chest expansion Breath sounds SpO2

BREATHING

Hyper-resonance/dullness Defects compromising breathing


Flail chest Sucking chest wound (Tx: tube thoracostomy)

WOB Effects of inadequate respiration


HR Mental state

Apply O2 face mask

CIRCULATION
Pulses
Presence Rate/rhythm

Colour
Cyanosis

Perfusion
Capill refill Peripheral temp

BP IV access

DISABILITY - AVPU
ALERT Responds to Voice Responds to Pain only Unresponsive

Pupillary light reflexes (*Squeeze one earlobe)

DISABILITY GCS
Eye opening (4)

Spontaneous Verbal stimuli Pain None Oriented (& converses) Disoriented (& converses) Inappropriate words Incomprehensible sounds No response
Obeys verbal command Localises Withdraws Flexor response (decorticate) Extensor response (decerebrate) None

Best Verbal response (5)

Best Motor response (6)

MONITOR
Mental state Airway, RR, SpO2 HR, BP, capill refill Deterioration in above
Primary survey MUST be repeated
Rectify problem

EXPOSURE
Look for:
External trauma (head toe)
Open wounds
Lacerations Abrasions Punctures Avulsions

Contusions

Fractures Other
Skin lesions Bite marks Discolourations

Log roll (posterior assessment)


Back/spine Buttock

VITALS
BP HR RR SpO2 Temp

History/Examination
HPI
Events related to current presentation Events leading up to presentation Any prior Tx/intervention

PHx
Brief: Medical and Sx Hx Medications Allergies Last meal

Systems R/V Examination


Relevant exams

Interventions/Investigations
Interventions
Reposition Rx
Drugs Fluids

Sx intervention

Investigations
Blood tests BSL U/A (blood) ECG Imaging
X-ray U/S CT

Inspect
Face

HEAD & FACE


Eyes (FB, subconjunctival haem, penetrating injury, hyphaema = blood in ant chamber) Ears (bleeding, bulging tympanic membrane) Nose (bleeding, nasal septal haematoma, CSF leak) Mouth (lips, gums, tongue, palate, teeth = subluxed, missing, loose, fractured)

Scalp
Battle sign (bruising behind ear = basal skull fracture)

Palpate
Scalp
Depressions/irregularities

Bony margins of:


Orbit Maxilla Nose Jaw (Pain, trismus/lockjaw = Persistent contraction of the masseter muscles due

to failure of central inhibition, malocclusion = Any deviation from a physiologically acceptable contact of opposing dentitions.)

Test

Eyes
Movements Vision Pupillary reflexes

Hearing

NECK
Inspect
Soft tissues
Trauma Neck veins
Distended Collapsed

Inability to move

Palpate
Cervical vertebrae Trachea Carotid pulse

CHEST
Inspect chest wall
Penetrating injury Deformities
Fractures Flail segment

Movements
Symmetrical

Palpate
Clavicular/rib tenderness

Auscultate
Lung fields Heart

ABDOMEN
Inspect abdo wall
Trauma: contusions/lacerations/penetrating injury Discolourations Swellings/masses

Palpate
Tenderness/enlargement
Especially over: liver, spleen, kidneys, bladder

Signs of peritonism (pain on palpation, guarding, rebound tenderness, rigidity)

Auscultate bowel sounds Inspect


Perineum External genitalia
Urethral bleeding Introitus bleeding

LIMBS
Inspect
All limbs and joints

Palpate
Bony/soft tissue tenderness Nerve/tendon damage

Joints
Movements Stability

Muscular power Neurological limb examination


Sensory Motor

BACK
LOG ROLL
Inspect
Entire length of back/buttocks/legs

Palpate
Spinal tenderness Steps between vertebrae

Weight estimation
(Age + 4) x 2 = weight
OR

3 x Age = weight
Children > 9years

Endotracheal Tube size


Age/4 + 4 = ETT size

Temperature
Minimise risk hypothermia
Limiting exposure during examination Warm fluids

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