Initial Assessment

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What are the major components of the initial assessment of the trauma patient?

The major components of the initial assessment of the trauma patient are primary survey and resuscitation, primary survey adjuncts, secondary survey, reevaluation as needed, and transfer to definitive care center (if necessary).

2

What is the purpose of the primary survey?

The purpose of the primary survey is to identify and treat life-threatening injuries, using a standard, reproducible approach, such as Advanced Trauma Life Support (ATLS).

3

What are the components of the primary survey?

The primary survey follows A, B, C, D, Es. A—airway: Management with inline cervical spine immobilization; B—breathing: Evaluate and treat oxygenation and ventilation; C—circulation: Evaluate core pulses (femoral, carotid), large caliber (14 g or 16 g) upper extremity peripheral IV access (two), hemorrhage control; D—disability: Brief evaluation of neurologic status—Glasgow Coma Scale (GCS), pupillary exam, lateralizing signs; and E—exposure and environmental control: Fully expose, keep warm.

4

What is the quickest way to assess the airway?

The fastest way to assess the airway is to ask the patient their name, or what happened. A clear accurate response in a normal voice tells you that the airway is patent, at least for now.

5

What are causes of upper airway obstruction in the trauma patient?

The main causes of upper airway obstruction in the trauma patient are the tongue (from direct injury or obtundation), blood, loose teeth or dentures, vomit, and soft tissue edema.

6

What are the initial maneuvers performed to manage an obstructed airway?

The initial maneuvers used to open an obstructed airway include positioning, such as a chin lift or jaw thrust, suctioning and removal of debris, and airway opening with oropharyngeal and nasopharyngeal tubes.

7

What are the indications for a definitive airway?

Indications for a definitive airway include apnea, inability to protect airway (traumatic brain injury or intoxication), hypoxia, hypo- or hyperventilation, shock, need for deep sedation (surgeries or reduction of dislocations), and to facilitate safe workup and treatment of a dangerous or extremely agitated patient.

8

What is a definitive airway?

A definitive airway is a tube in the airway with cuff inflated below the vocal cords. It must be connected to oxygen and secured in place.

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