Dr George Mukhari Academic HospitalDepartment of Surgery

Trauma UnitUniversity of Limpopo

Apply principles of primary and secondary surveys

Identify management priorities

Institute appropriate resuscitation and monitoring

History and biomechanics of injury

Anticipate pitfalls

Resuscitation

Definitive Care

Reevaluation

Primary Survey

Adjuncts

Detailed

Secondary

Survey

Reevaluation

Team Approach

Simultaneous

Gown

Gloves

Mask

Shoe Covers

Goggles / face shield

Sorting of patients according to

ABCDEs

Available resources

Identify yourself

Ask the patient his / her name

Ask the patient what happened

A Patent airway

C D Clear sensorium

B Sufficient air reserve to

permit speech

If no response, proceed with

rapid primary survey

A Airway with c-spine protection

B Breathing

C Circulation with hemorrhage control

D Disability

E Exposure / Environment

Trauma in the elderly

Pediatric trauma

Trauma in pregnant women

Establish patent airway

Protect c-spine

Pitfalls?

Equipment failure

Inability to intubate

Occult airway injury

Progressive loss of airway

Level of consciousness

Skin color and temperature

Pulse rate and character

Control hemorrhage

Restore volume

Reassess parameters

Special care

Elderly

Children

Athletes

Medications

Disability

Basic neurologic evaluation

GCS scoring

Pupillary response

Completely undress the patient

Protect and secure airway

Ventilate and oxygenate

Stop the bleeding!

Prevent hypothermia

ADJUNCTS

Vital signsABGs

Pulse

oximeter

and capnograph

Urinary / gastric catheters

unless contraindicated

Urinary

output

ECG

DPL

FAST

Diagnostic Tools

Complete Examination of patient

Primary survey is completed

ABCDEs are reassessed

Vital functions are returning to normal

After

History

Physical exam: Head-to-toe

PR + PV

Complete neurologic exam

Special diagnostic tests

Reevaluation

A

M

P

L

E

History

Allergies

Medications

Past illnesses

Last meal

Events / Environment

MVABlunt + sharp assault

Fall

Burns

GCS Score

Neurologic exam

Comprehensive eye and ear exam

Head

Bony crepitus

Deformity

Malocclusion

Potential airway obstruction

Maxillofacial

Tenderness

Complete motor / sensory exams

Reflexes

Imaging studies

↓ GCS

Cervical Spine

Pitfalls?

Mechanism: Blunt vs penetrating

Symptoms: Airway obstruction,

hoarseness

Findings: Crepitus, hematoma, stridor,

bruit

Neck (soft tissues)

Inspect

Palpate

Percuss

Auscultate

Obtain x-rays

Chest

Inspect

Auscultate

Palpate

Percuss

Reevaluate

Special studies

Abdomen

Hollow viscus injury

Retroperitoneal injury

Excessive pelvic manipulation

Abdomen: Pitfalls?

Secondary Survey

Rectum Sphincter tone, high-riding

prostate, pelvic fracture,

rectal wall integrity >> Blood / Lacerations

Vagina

Contusions, hematomas,

lacerations, urethral blood

Examine

Perineum

Contusion, deformity

Pain

Perfusion

Peripheral neurovascular status

X-rays as needed

Musculoskeletal: Extremities

Pain on palpation

Symphysis width

Leg length unequal

Instability

X-rays as needed

Musculoskeletal: Pelvis

Potential blood loss

Missed fractures

Soft-tissue or ligamentous injury

Compartment syndrome (especially with altered sensorium / hypotension)

Musculoskeletal: Pitfalls

GCS Score

Lateralizing signs

Frequent reevaluation

Prevent secondary brain injury

Neurologic: Brain

Refer Neurosurgeon

Complete motor and sensory exams

Imaging as indicated( CT, MRI )

Reflexes

Neurologic: Spine and Cord

Secondary Survey

Neurologic: Pitfalls

Incomplete immobilization

Subtle in ICP with

manipulation

Rapid deterioration

Special diagnostic tests as indicated

Pitfalls?

Patient deterioration

Delay of transfer

High index of suspicion

Frequent reevaluation and monitoring

Relief of pain / anxiety as appropriate

Administer intravenously

Careful monitoring is essential

Those whose injuries exceed

institutional capabilities

Examples

Multisystem or complex injuries

Patients with comorbidity or age extremes

As soon as possible after stabilizing

measures are completed

Airway and ventilatory control

Hemorrhage control (operation)

Concise, chronologic documentation

Consent for treatment

Forensic evidence

QUESTIONS