Primary Trauma Survey

Airway Management and Cervical Spine Immobilization

■ Open airway using the jaw-thrust method.

■ Assess airway for compromise and/or obstruction.

■ Suction nasal/oral pharynx to clear blood, secretions, or debris.

Breathing and Ventilation

■ Assess respirations for rate, depth, quality, and effort.

■ Inspect and palpate chest and auscultate lung fields for diminished or absent breath sounds if ventilation is abnormal.

■ Manually ventilate with a BVM if breathing absent or inadequate.

Circulation and Hemorrhage Control

■ Assess pulse for presence, quality, and regularity.

■ Begin chest compressions if no pulse can be detected.

■ Assess skin color, temperature, moisture, and capillary refill.

■ Control hemorrhage with direct pressure.

Disability

■ Determine and establish a baseline GCS Score (may use AVPU).

■ Assess pupils: PEARRL (pupils equal and round, reactive to light).

Expose/Environment

■ Remove clothing and assess entire Pt for injury and hemorrhage.

■ Maintain body temperature by keeping the Pt covered.

■ Log roll to inspect and palpate posterior surfaces.

■ Immobilize entire body using a c-spine collar and long board.

Special Considerations

IV Fluids and Blood

■ LR is the fluid of choice in trauma Pts. Caution: LR contains calcium, which causes donor blood to clot in the IV tubing. If a blood transfusion is likely, then NS is the fluid of choice.

Pregnancy

■ Cervical spine immobilization Pregnant women (>24 wk) should be immobilized in the left lateral position if possible to avoid compression of the vena cava, which causes supine

hypotension.

Mechanism of Injury

■ Motor vehicle accidents (MVA) Direction of impact, speed at impact, condition of vehicle, use of seatbelts or airbags, ejection from vehicle, was any other passenger from the same

vehicle killed, delayed transport due to extrication from vehicle, chest or abdominal bruising from steering wheel or seatbelt.

■ Falls From what height and onto what type of surface.

■ Penetrating trauma Weapon, site and depth of injury, underlying organs, weapon-patient distance, caliber and velocity of bullet.

■ Burn injuries Degree of burns, % total body surface area (TBSA), associated trauma.

Revised Trauma Score (RTS)

Component	Finding	Value	Score
Respiratory Rate	10–29/min > 29/min 6–9/min 1–5/min Apnea	4 3 2 1 0
Systolic Blood Pressure	> 89 76–89 50–75 1–49 Pulseless	4 3 2 1 0
Glasgow Coma Scale Score	13–15 9–12 6–8 4–5 0–3	4 3 2 1 0