What is the primary survey in trauma?

aka Trauma Tribulation 014

Your trauma patient from Trauma Tribulation 013 has arrived… A trauma call was activated and the team assembled. The patient was transferred onto a bed in the trauma bay, and removed from a spinal board used fro transfer. Handover and vital signs are being obtained as the trauma team get to work.

As the Trauma Team Leader, you’re going to need to know your stuff to be able to coordinate the team’s initial assessment and management of this trauma patient.

Questions

Q1. What are the 5 key components of the primary survey in major trauma?

Answer and interpretation

ATLS [8th edition] emphasizes the ABCDE approach:

• Airway maintenance with cervical spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
• Disability [neurological status]
• Exposure and environmental control [completely undress the patient but avoid hypothermia]

This assessment can usually be performed in less than 10 seconds.

Handy tips:

• Talk to the patient. Any verbal response strongly suggests that for the moment at least their ABCDE’s are okay!
• Once identified, deal with a problem BEFORE moving on in your assessment [this is encapsulated by the mantra “FIND the bleeding, STOP the bleeding”].
• After any intervention, return to the start of the primary survey.

Q2. What does airway maintenance with cervical spine control involve?

Answer and interpretation

Airway assessment and maintenance:

• Ensure patency and consider if airway protection is required.
• Escalate from simple to advanced techniques as required.
•  Suction and Magill’s forceps should be immediately available.
• Employ simple airway maneuvers – jaw thrust and chin lift. Head tilt inappropriate with cervical spine control.
• Use airway adjuncts – oropharyngeal airway usually only a temporizing measure if tolerated as usually requires definitive airway. Nasopharyngeal airways are inappropriate in head and facial trauma due to risk of intracranial passage.

Consider the need for a definitive airway, which may be required for A, B C or D reasons:

• A – eg: impending airway obstruction [burns, penetrating or blunt neck injury] or injury that may distort airway anatomy [e.g. neck hematoma]
• B – eg: Respiratory insufficiency due to a large pulmonary contusion, flail chest, or other thoracic injury.
• C – eg: multisystem trauma with shock
• D – eg: Reduced GCS [especially