Primary survey in Trauma
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![Page 1: Primary survey in Trauma](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a731fd1a28ab64028b46f9/html5/thumbnails/1.jpg)
Initial assessment Primary survey
Dr Vinod Jain
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Objectives
• To understand the ATLS principles during
primary survey
• To know the application of adjuncts
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Case scenario
• 25 years old male, unrestrained car driver with high speed head-on collision, brought by police ambulance
• HR 110/mt, RR 32/mt, BP 100/80, Pale skin
• Unresponsive with alcoholic smell
• Bleeding wound right thigh and left hand with deformity
• Noisy breathing
• Bruises on anterior chest wall
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Case scenario
• Should be managed by single person or
by a team?
• Is it important to assign work to different
team members?
• Prior basic information of patient’s
condition is helpful or not?
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Case scenario
What is the sequence of priorities in assessing
this patient?
• Should we identify the specific injuries
before initial management of this patient?
• If not, how should we proceed?
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ATLS way of trauma management
• Preparation
• Triage
• Primary survey (ABCDEs)
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Continuous post resuscitation monitoring and re evaluation
• Definitive care
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Preparation
• Take universal precautions
• Check the availability of medicines and
functioning of equipments
• Designate the role to each team member
• Utilize pre hospital information
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Initial assessment
• Primary survey – Evaluates physiology
• Secondary Survey – Evaluates anatomy
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Primary survey
Primary survey and resuscitation of vital
functions are done simultaneously using a
team approach
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Primary Survey – ATLS way
• Airway with c-spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
• Disability: Neuro status
• Exposure with environmental control
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Primary Survey
Always consider physiological
variations in special populations
● Elderly
● Infants and Children
● Pregnant Women
● Obese
● Athletes
The priorities are same for all the patients
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Quick Assesment
What is a quick, simple way to assess a
patient in 10 seconds?
•Ask the patient his or her name?
•Ask the patient what happened?
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Appropriate Response confirms
1 – Patent airway
2 – Sufficient air reserve to permit speech
3 – Sufficient perfusion
4 – Clear sensorium
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Primary survey
Airway – Establish patent airway with c-spine
protection
• Clear the airway using wide bore suction
• Chin lift / Jaw thrust manoeuvre
• Oropharyngeal / nasopharyngeal airway
• Definitive airway
(Cuffed, Secured endotracheal tube)
• Surgical airway
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15
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Primary Survey
Breathing and ventilation –
assess and ensure adequate
oxygenation and ventilation
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Breathing and Ventilation
Assess
• Jugular venous distension
• Position of trachea
• Respiratory rate
• Percussion findings of chest
• Air entry
• Oxygen saturation
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Breathing and ventilation
Recognise and treat early –
• Tension pneumothorax
• Flail chest with pulmonary contusion
• Massive haemothorax
• Open pneumothorax
Immediate Chest decompression with
Oxygen delivery
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Circulation with haemorrhage control
After excluding tension pneumothorax,
cause of hypotension is hypovolemia until
proved otherwise
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Circulation with haemorrhage control
Look for blood loss
– External bleeding
– Internal bleeding
• Chest
• Abdomen / Retroperitoneum
• Pelvis
• Long bones
One on floor four more
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Circulation with haemorrhage control
Assess for organ perfusion
● Level of consciousness
● Skin color and temperature
● Pulse rate and character
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Primary Survey
Circulatory Management
● Control hemorrhage
● Restore volume
● Reassess patient
Pitfalls
● Elderly
● Children
● Athletes
● Medications
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D- Disability : Neurologic status
Rapid neurological examination is done for -
- Level of consciousness (GCS)
- Pupillary size and reaction
- Localizing signs
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Primary survey - E
• Expose the patient
• Prevent hypothermia
• Cover with warm blanket
Patient’s body temperature is more
important than comfort of
healthcare providers
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Assessment and Resuscitation
is
done
simultaneously
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Adjuncts to Primary Survey
PRIMARY SURVEY
ABGs
Urinary / gastric cathetersunless contraindicated
Urinaryoutput
ECG Vital signs
Pulseoximeterand CO2
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Adjuncts to Primary Survey
Diagnostic Tools
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Adjuncts to Primary Survey
Diagnostic Tools
• FAST
• DPL
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Parameters of improvement
Normalization of
• Pulse rate
• Blood pressure
• Ventilatory rate
• Arterial blood gases (ABG)
• Body temperature
• Urinary output
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Transfer
• Consider transfer after stabilization
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Transfer protocol
Inform the receiving doctor about
• Patient’s history including mechanism
• Physical findings
• Treatment instituted
• Patient’s response to therapy
• Diagnostics tests performed and result
• Need for transport
• Method of transportation
• Anticipated time of arrival
Continue ABCDEs with continuous monitoring
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Questions
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Take home message
33
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Take home message
• We should have competent and co-ordinated team for trauma care
• Correct and sequential ATLS approach is needed• Primary survey includes simultaneous assessment
and treatment of trauma patient • Priorities of resuscitation remain same in various
population of trauma patients• Proper transfer protocol should be followed