Primary Survey Flashcards
When to put out a trauma call.
a) Mechanism
b) Patient factors
c) Specific injuries
d) Patient observations
a) - Fall from height > 3 feet (5 steps)
- High velocity - RTC, bicycle crash
- Axial load to head - eg. diving
- Penetrative - eg. stabbing, gun shot, explosion
- Burns, flames, smoke inhalation
b) - Pregnancy
- Elderly/ at risk
c) - Pneumothorax
- Flail chest
- Reduced GCS/
- Massive haemorrhage
- Head injury
d) - Shock
- Unstable/ deteriorating
ATMIST
Age Time of arrival/ time of event Mechanism of injury Injuries suspected Signs (vitals) Treatments already initiated (by paramedics, pre-hospital team)
Red phone goes off - high speed RTC. Patient blue-lighted and will arrive in 5 minutes
- what should you prepare
- Put out trauma call
- Assesmble team and brief team
- Allocate roles - team leader
- Prepare kit
- Contact CT
- Pre-alert blood bank
ED trauma team
- Team leader (usually most senior member of ED team)
- Airway (anaesthetist ideally)
- Primary survey clinician
- Circulatory access and bloods
- 2x nursing staff - airway assistance, observations and drug administration
- Radiographer
- Scribe
Hospital trauma team (tertiary trauma centre)*
*DGH will just have ED trauma team
- General surgery
- Orthopaedics
- Anaesthetics/ITU
- Cardiothoracics
- Vascular
- Obstetrics
- Paeds
- Radiology
cABCDE
Catastrophic haemorrhage Airway Breathing Circulation Disability Exposure
Catastrophic haemorrhage
a) What is it? - causes?
b) Management
- Immediate* life threatening exsanguination (eg. amputation or other profuse bleeding point)
- Apply torniquet or compression bandage
+/- haemostat agents (eg. Quikclot)
*Will kill you before an airway problem
Airway.
a) and ….?
b) What is triple immobilisation
c) How to assess airway?
d) Signs of obstruction
e) Causes of traumatic airway problem
f) Management
a) C-spine stabilisation
b) Collar, blocks and tape
(also will be on a spinal board)
c) - Are they speaking with normal voice?
- Look in and around the mouth (eg. blood, vomit, loose teeth, max-fax injuries)
- Listen to breathing
- Look at chest movements
d) - Listen (stridor, snoring, grunting, secretions)
- See-saw breathing
- Cyanosis, hypoxia
- Hoarse voice (?inhalation injury - look for ), drooling
e) - Reduced GCS
- Burns - inhalation injury (look for facial burns, singed eyebrows/eyelashes, carbaceous sputum)
- Facial injury
f) - Suction
- Airway manoeuvres
- Adjuncts
- Intubate (alert anaesthetics)
- Front of neck access - cricothyroidotomy and create tracheostomy
Breathing
a) assessment
b) imaging?
c) management
a) - Observations - SpO2, RR
- Look - any obvious injuries, fractures, wounds, flail chest, respiratory distress, etc.
- Palpate - expansion, tenderness
- Percuss (?pneumothorax, haemothorax)
- Auscultate - air entry, added sounds
b) - Not for tension pneumothorax - clinical diagnosis!
- Haemothorax - whiteout of hemithorax
c) - Tension/large pneumothorax - needle decompression, chest drain, open pneumothorax - needs dressing
- Haemothorax - if massive, IV access, bloods + fluids (consider major haemorrhage protocol), then chest drain
- Flail chest - pain relief, may need nerve block
- Oxygen
- Ventilation
Circulation.
a) assessment
b) management
c) where can be blood be lost to?
mnemonic: 1 on the floor + 4 more
d) imaging?
a) - Observations - tachycardic, hypotensive
- CRT, pulse volume, temperature (cool peripheries), colour (pale, cyanosed)
b) - IV access
- Bloods
- Fluids
- Blood products
- Consider major haemorrhage protocol
- Pelvic binders and splints
- Needle pericardiocentesis/ open thoracotomy
- ITU if need vasopressors/inotropes
- Surgery - vascular, orthopaedics, cardiothoracic, obstetric, etc.
c) - 1 on the floor (check bed, clothes + surroundings)
- and 4 more: thorax, abdomen, pelvis, long bones
- Consider tamponade in penetrating chest trauma
d) FAST scan
- Focused Assessment with Sonography for Trauma
- US scan
- Looks in hepatorenal angle, splenorenal angle, suprapubic space for free fluid in abdomen
- Also looks at pericardium for tamponade (Beck’s triad: muffled heart sounds, hypotension, raised JVP)
Other
- ECHO
- Angiogram
- CXR
Disability.
a) 3 core things always to assess
b) Specifically for trauma
c) Outline GCS
a) GCS/AVPU, pupils, glucose
b) Head injuries.
- ?boggy mass, signs of basilar fracture
- pupillary reflexes, AVPU, GCS
- other neurology - sensory level, weakness, CES / cord compression, etc.
- Log rolling - maintains spinal alignment while moving patient for patients with suspected spinal injury
DEFG - glucose
c) - E4 - spontaneous, to voice, to pain, no opening
- V5 - VOICE (voiceless,
- M6 - OLDBEN (obey commands, localise to pain, draws from pain, bends, extends, no response)
Exposure.
- Temperature - beware hypothermia
- Abdomen
- Long bones
- Pressure areas
- Urinary retention - could be blood clot causing this, indicating urological trauma
Life threatening diagnoses in the chest to look for in primary survey.
- Mnemonic: ATOM FC
- Airway obstruction
- Tension pneumothorax
- Open pneumothorax
- Massive haemothorax
- Flail chest
- Cardiac tamponade
After primary survey.
a) Initially
b) Then
a) - Stable - CT scan
- Unstable - durther resus / theatres/ ITU
b) Secondary survey.
- Top to toe survey
