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
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
Establish patent airway
Protect c-spine
Pitfalls?
Equipment failure
Inability to intubate
Occult airway injury
Progressive loss of airway
Control hemorrhage
Restore volume
Reassess parameters
Special care
Elderly
Children
Athletes
Medications
ADJUNCTS
Vital signsABGs
Pulse
oximeter
and capnograph
Urinary / gastric catheters
unless contraindicated
Urinary
output
ECG
History
Physical exam: Head-to-toe
PR + PV
Complete neurologic exam
Special diagnostic tests
Reevaluation
Mechanism: Blunt vs penetrating
Symptoms: Airway obstruction,
hoarseness
Findings: Crepitus, hematoma, stridor,
bruit
Neck (soft tissues)
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
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)
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