Dr Kupe

Primary survey

Airway maintenance with cervical spine protection

Assess airway

Open airway- chin lift, jaw thrust

Breathing and ventilation

Identify 6 life threatening conditions

1.Airway obstruction

2.Tension pneumothorax

3.Open Pneumothorax

4.Massive Haemorrhage

5.Flail chest

6.Cardiac tamponade

Circulation with hemorrhage control

Give crystalloid solution or blood

Disability/Neurologic assessment

• AVPU (alert, verbal stimuli response, painful stimuli response, or unresponsive)
• GCS
• Pupil size, lateralizing sign
• 
  

Exposure and Environmental control

Undress, cut garments

Warm blanket- prevent hypothermia

Secondary Survey

Complete history,

AMPLE history.

• A    Allergies
• M   Medications (Anticoagulants, insulin and cardiovascular medications especially)
• P    Previous medical/surgical history
• L    Last meal (Time)
• E    Events /Environment surrounding the injury; ie. Exactly what happened

Physical examination

1. Head and face

   a. Posterior scalp lacs/compound skull fractures

   b. Pupil changes since primary survey

   c. Visual deficits

2. Neck

   a. Injuries under the hard collar are not seen

   b. In line immobilisation while the collar is off

3. Chest

   a. Clinical ribs # and sterna # are missed

       i. many do not show on the chest X-ray

       ii. they can compromise the patient

       iii. X-ray 'proof' is not required

4. Abdomen

   a. Pain or tenderness or bruising requires further investigation

   b. The inaccessible abdomen with appropriate mechanism requires investigation.

       i. FAST or DPL in the unstable

       ii. CT in stable patients

   c. Vaginal examination in female patients with pelvic fractures or vaginal bleeding. In pregnancy this examination should be deferred to an obstetric specialist.

   d. A nasogastric tube is contraindicated in the presence of facial fractures (an orogastric tube should be inserted)

   e. a urinary catheter should only be inserted if there is no blood at the urethral meatus, no perineal bruising, and rectal examination is normal.

5. Back

   a. Log roll takes 5 people, 3 body, one head, one examining

   b. Inspection and palpation

   c. Perform the rectal examination at this time.

6. Extremities

   a. Inspect and palpate each limb for tenderness, crepitatior abnormal movement.

   b. If the patient is cooperative ask him or her to move the limbs in response to command in preference to passive movement in the first instance.

   c. Adequately splint any injuries.

   d. Reassess after splints, traction or manipulation

7. Neurological examination

   a. Repeat the Glasgow Coma Scale - record scores for E, V and M as well as the total score

   b. Re-evaluate the pupils

   c. Look for any localising/lateralising signs

   d. Look for signs of cord injury

8. Hidden Injuries    

a. Pulmonary contusion/Pneumothorax

b. aortic injury

c. myocardial injury

d. diaphragm

e. oesophageal injury

f. trachea/ bronchus injury

g. pneumothorax