Trauma basics 1

Important - Hypoxia and hypotension kill head-injured patients.  

Background
 

The management of trauma in the first hours after injury significantly affects the final outcome.   
 

 

Triage

Severely injured patients are triaged category 1 or 2 and are treated in the Resuscitation area.
The trauma team should be called, according to local protocol.    
 

Principles of trauma management

Assume the spine is damaged until proven otherwise and protect the neck with a rigid cervical collar +/- sandbags. Log roll patient when turning.    
 

Primary survey

Performed rapidly by the team leader (should take approx. 1 minute).
- The Primary Survey is based on the acronym 'A B C D E ' where:

A = Airway and cervical spine
B = Breathing,
C = Circulation,
D = Disability
E = Exposure    
 

A = Airway AND cervical spine

- Rapidly assess patency of upper airway. This takes precedence over everything else.
- The cervical spine should be stabilised by a rigid collar +/- sandbags +/- tape, or should be held by a person.    
 

B = Breathing

- Assess adequacy and symmetry of air entry into the lungs.
- Assess chest wall for flail segments, sucking wounds or other mechanical impediment to ventilation.
- Check for pneumothorax.
- Note the pattern of breathing (patients with spinal injury may only have diaphragmatic breathing).     

C = Circulation
 

- Blood pressure, pulse rate and volume, skin colour, temperature and sweating.
- Decide if patient is shocked or imminently shocked and if so, quickly look for signs of tension pneumothorax or cardiac tamponade.    

D = Disability

- Make a rapid initial assessment of CNS and Spinal disability.
- Assess level of consciousness with 'A V P U' ( not Glasgow Coma Score at this stage):

A = Alert
V = Responds to Voice
P = Responds to Pain
U = Unresponsive

Look for signs of spinal injury - movement, bradycardia, priapism, vertebral tenderness.    
 

E = Exposure

- Remove the patient's clothes. The patient should be log rolled, and the thoracolumbar spine and rectal/ vaginal examinations performed. 

 

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