Trauma Primary Survey

Systematic approach to the presenting trauma patient is critical to quickly identify life-threatening acute concerns. The seven primary survey steps can be completed in minutes and may be remembered with the mnemonic ABCDEFG.

  • Airway and Cervical Spine
  • Breathing and Ventilation
  • Circulation and Hemorrhage
  • Neurologic Status
  • Exposure and Environment
  • FAST Exam
  • Glucose and Girl

Airway and Cervical Spine

Airway control is mandatory; all else hinges on this. The tongue is the most common obstruction in the unconscious patient.

  • Assume cervical spine injury
  • Clear the airway of blood, mucus, dental fragments
  • Consider facial fractures, tracheal injury and neck trauma
  • Evaluate altered level of consciousness and risk of aspiration
  • Open airway with jaw thrust and consider oral or nasal airway
  • Secure advanced airway if indicated. Consider use of elastic bougie and video laryngoscopy. Maintain manual inline c-spine stabilization

Breathing and Ventilation

Evaluate O2 sat, work of breathing, respiratory rate and Chest XRay.

  • Evaluate for pneumothorax
  • Identify rib fractures (especially first 3 ribs) as well as flail chest.
  • Consider pulmonary contusion.
  • Cover open chest wounds (3 sides only if a sucking chest wound)
  • Open airway with jaw thrust and consider oral or nasal airway
  • Consider bilateral chest tubes in the crashing trauma patient

Circulation and Hemorrhage

Evaluate LOC, skin color, central pulses, sites of rapid blood loss.

  • Obtain 2 large bore IVs and replace lost blood with blood (esp fo MAP 65, persistent tachycardia, massive blood loss)
  • Control external pulsatile bleeding immediately (temporize with tourniquet or suture)
  • Consider internal hemorrhage (intra-abdominal or intra-thoracic injury)
  • Consider high risk fracture sites (femur fracture, pelvic fracture)
  • Evaluate for penetrating trauma in region of large vessels

Neurologic Status

Evaluate GCS, AVPU and pupil response as well as motor and sensation in all extremities. An unconscious trauma patient has a bilateral cerebral cortex injury or a brain stem injury.

  • Evaluate for closed head injury
  • Consider drug and alcohol intoxication
  • Consider hypoxia and shock as underlying etiologies for altered level of consciousness
  • Assess GCS and extremity neurologic function prior to Rapid sequence intubation

Exposure and Environment

Trauma patients should be completely undressed and visually inspected (including log roll).

  • Do not forget the hidden sites: Armpits, Back, Butt cheeks and Sac.
  • Prevent hypothermia - apply warm blankets and administer warmed crystalloid

eFAST Exam

Trauma ultrasound is performed with a low frequency (3-5 MHz) curved linear probe. All views are performed with indicator at 12:00 except for the sub-costal view which is oriented instead at 9:00.

  • Sub-costal or SubXiphoid view: Pericardial effusion
  • Right intercostal oblique: Right hemothorax
  • Right coronal: Blood in Morrison's pouch, paracolic gutter, retroperitoneum
  • Left intercostal oblique: Left hemothorax
  • Left coronal: Blood adjacent to spleen or in left paracolic gutter
  • Left suprapubic): Blood in Douglas Pouch (pelvis)
  • Bilateral lung apices: Pneumothorax)

Glucose and Girl

Remembering to check a bedside glucose and pregnancy test can avoid a few major pitfalls.