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Th e Pr im ary Su rv ey

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Identify sources ofbleeding that may be

contributing tohypotension

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45 yr male

high speed MVAejected throughwindshield.

Arrives c-spineimmobilized.Intoxicated.

Alert, butbelligerant.Multiple faciallacerations.

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Temp: 99.1HR: 124Resp.rate: 25BP: 100/70

O 2 Sat.: 94%

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What are the management priorities at thistime?

What are this patient

s possible injuries?

What are the interventions that need tohappen now?

Simultaneously

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A

G

FD ECBL

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Neuro.Before

AirwayHead-of-the-bed-guy: GCS, assessing airway and potential for difficult airway,and can they move all 4 extremities(no sensory exam needed)

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Eyes ? Motor ? Voice ?

Hey buddytalk to mesqueeze my hand .

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EYE VERBAL MOTORSpontaneous 4 Oriented 5 Obeys 6

Verbal 3 Confused 4 Localizes 5

Pain 2 Words 3 Flexion 4

None 1 Sounds 2 Decorticate 3

None 1 Decerebrate 2None 1

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Lung Guy:Evaluating the

breath sounds

Are bilateral breath sounds reassuring?

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19/58Needs Positive Pressure Ventilation

Lung Guy:and palpatingthe chest wall

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20/58Lung Guy:

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22/58Lung Guy:

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23/58Lung Guy:

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Wh ere i s the in jury?

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Wh ere i s the in jury?

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Lung Guy:

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1. Armpits

2. Back3. Butt cheeks4. Sack

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Look for distension, tenderness, seatbelt marks, penetratingtrauma, retroperitoneal ecchymosis

Be suspicious of free fluid without evidence of solid organinjury

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Focused Abdominal Scanning in Trauma

5 views: Cardiac, RUQ, LUQ, suprapubic + LUNG

Goal: evaluate for free fluid

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Trauma is best managed by a team approach

(there

s no

I

in trauma)

A thorough primary and secondary survey is key to identifylife threatening injuries

Once a life threatening injury is discovered, interventionshould not be delayed

Disposition is determined by the patient

s condition as well

as available resources.

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Brea th ing

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Circula t ion

C-Spine

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Expose

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Girl = HCG

Glucose

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His tory

Han g A n t ib io t i c sHead -to -To e Exam

and prevent

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In jec t Pain Med s

In jec t tetan u s

N t OR CT t bili d d t t d

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Next: OR, CT or stabilized and start secondary survey

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