Primary Survey and Secondary Survey
AIRWAY: look, listen and feel
- C-spine precautions
- Definitive airway for GCS </= 8, blood, shock, inhalation injury, burns
- Chin lift, jaw thrust, oropharyngeal airway, nasopharyngeal airway
BREATHING
- O2 non rebreather mask @ 15 L/min
- O2 Sat, Resp rate and rhythm
- Percussion
- Breath sounds
- CT for pneumothorax
CIRCULATION
- HR, BP, O2 Sat, pulses
- Shock @ 1500 cc blood loss, fatal @ 2000 – 2500cc
- U/S, CT abdomen
- Differential Diagnosis
- Cardiogenic
- Hypovolemic
- Distributive (neurogenic, septic, anaphylactic, addisonian)
- Obstructive (Pulmonary embolism, tamponade, pneumo)
- Signs and Symptoms of shock
- Narrow pulse pressure in early hypovolemic
- Decreased LOC
- Decreased U/O (Normall is 0.5cc/kg/hr, 1cc/kg/hr in kids, 2cc/kg/hr in infants)
- Tachycardia
- Hypertension
- Cold clammy in hypovolemic
- Warm pink in neurogenic
- Tachypnic
- Sources of Blood loss
- Pelvis and retroperitoneum (check for stability)
- Long bones (2L/femur, 1.5L/tibia)
- Abdomen
- External
- Chest
- Treatment
- Direct pressure
- Vascular access
- Volume Resuscitation
- Find Source
- Control bleeding
DISABILITY/ENVIRONMENT/EXPOSURE
- GCS
- Pupils
- Examine all surfaces
- Exposue adequately
- Prevent hypothermia with warmed fluid, blankets
Adjucts
- EKG
- Pulse Oximetry
- ABG
- NG/OG
- Foley catheter
- Chest x-ray
- Pelvic x-ray
- 2 large bore IVs
Life threatening chest injuries
- Pneumothorax
- Hemothorax
- Open chest wound (sucking – requires 3 sided seal with chest tube)
- Flail chest (2 or more rib # in 2 or more places)
- Aortic arch injury (sudden deceleration, fixed at ligamentum arteriosum)
- Pulmonary contusion
- Cardiac tamponade
- Diaphragmatic rupture (spleen injury)
Management
- IVs – 2 large bores
- Monitors (O2, EKG, BP)
- Foley
- Investigations
- NG tube
- X-rays (CXR, lat C spine, pelvic)