Emergency Assessment

Primary Survey
■ Airway with cervical spine immobilization
■ Breathing and ventilation
■ Circulation with hemorrhage control
■ Disability (pupils, posturing, seizures, Glasgow Coma Score [GCS])
■ Expose/Environment

Airway
Assessment
■ Can the Pt speak comfortably?
■ Inspect the oropharynx for foreign objects, blood, and injury.
■ Are there audible abnormal sounds? Wheezing? Stridor?
■ Are there signs of hypoxia or obvious trauma to the airway?

Airway Interventions (1)
■ Establish patent airway with:
■ Jaw-thrust method.
■ Suctioning to clear blood, vomitus, secretions, and debris.
■ Oral or nasopharyngeal airway. Caution: Nasal airways are contraindicated in the presence of facial trauma.
■ Immobilize cervical spine.

Airway Interventions (2)
■ Endotracheal intubation—indications:
■ Protect airway and ensure patency.
■ Correct hypoxemia.
■ Severe head injury or GCS 8.
■ Confusion or fluctuating LOC requiring head CT (computed tomography).
■ Tracheostomy if unable to ventilate or intubate.

Breathing
Assessment
■ Assess rate and ease of breathing.
■ Check nail beds and circumoral area for cyanosis.
■ Is the Pt restless?
■ Feel trachea, percuss chest, and auscultate lungs.
■ Evaluate arterial blood gas (ABG) results.

Breathing Interventions
■ Provide 100% supplemental oxygen via NRB mask.
■ Manually ventilate if necessary with BVM.
■ Identify and treat major thoracic injuries: Pneumothorax (simple, or tension, sucking chest wound), hemothorax, rib fractures, flail chest.

Circulation
■ Check pulse and BP.
■ Check peripheral perfusion.
■ Insert two large-bore IVs.
■ Send blood for type and cross-match.

Disability
■ Initial neurological assessment is limited to checking pupils and assessing level of responsiveness using the AVPU or GCS:
■ AVPU: A—Alert, V—Responds to Voice only, P—Responds to Pain only, or U—Unresponsive.
■ GCS: See Glasgow Coma Scale.
■ Any change in AVPU requires reassessment of ABCs.

Expose/Environment
■ Remove clothing and inspect for obvious injuries.
■ Cover Pt to reduce heat loss.

Secondary Survey
■ Follows primary survey and resuscitation.
■ Involves systematic and thorough head-to-toe assessment for undetected injuries.
■ Includes AMPLE history (Allergies, Medications, Past medical history, Last meal eaten, Events prior).
■ Includes continuous reassessment of primary survey.
■ Provides for assessment of each body area for signs of deformity, contusion, abrasion, hemorrhage, penetrating injury, altered perfusion, and altered function.

Complete Head-to-Toe Assessment
Head and Face
■ Inspect and palpate head and face for lacerations, contusions, fractures, or other injuries.
■ Eyes (injury, hemorrhage, contact lens, dislocation of lens).
■ Ears and nose for CSF (cerebrospinal fluid).
■ Mouth (blood, emesis, broken or missing teeth).
■ Cranial nerves.

Cervical Spine and Neck
■ Inspect for signs of injury, tracheal deviation.
■ Palpate for tenderness, deformity, swelling, subcutaneous emphysema.
■ Auscultate for carotid bruits.

Chest
■ Inspect for injury, use of accessory muscles.
■ Palpate entire chest for tenderness, crepitation, and injury.
■ Percuss for hemothorax (dullness) or pneumothorax (tympany).
■ Auscultate lung sounds and compare left to right.

Abdomen
■ Inspect for distension, skin condition.
■ Auscultate for bowel sounds.
■ Percuss.
■ Palpate: soft or rigid, tender or nontender?

Extremities
■ Inspect for signs of injury or deformity.
■ Palpate for sensation, tenderness, crepitation, abnormal movement.
■ Check all pulses.

Perineum
■ Inspect for rectal bleeding or injury. Assess sphincter tone.
■ Inspect for bleeding, priapism (males), or injury to genitalia.

Back and Spine
■ Inspect for injuries, hematoma, swelling.
■ Palpate spine for tenderness, flank pain.

Fractures—Dislocation
■ Bone or joint deformity.
■ Loss of function.
■ 6 Ps: Pain—Pallor—Pulse—Polar—Paresthesia—Paralysis.

Neurological
■ Reevaluate pupils and LOC.
■ Determine and document GCS.
■ Evaluate extremities for weakness or loss of sensation.

Diagnostic Studies
■ Type and cross-match for blood
■ Hemoglobin and hematocrit
■ White blood cell count
■ Glucose
■ Urinalysis
■ Amylase
■ Cardiac and liver enzymes
■ Arterial blood gas
■ Cervical spine radiographic series
■ Chest x-ray
■ Head and abdominal CT