2044637_635248627356345000
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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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