TRAUMA ASSESSMENT

PRIMARY SURVEY AIRWAY – Assess for patency/obstruction Chin lift/ jaw thrust Clear FB’s Oropharyngeal airway Intubation/surgical airway Maintain cervical spine stabilization

BREATHING – Expose neck and chest – Rate and depth of respirations – Inspect/palpate neck and chest – Auscultate – Immediately manage Apnea Pneumothorax – Open – Tension

CIRCULATION – Identify external exsanguinating hemorrhage – Identify potential internal hemorrhaging – Assess pulse- quality, rate – Skin color – Blood pressure – Immediately manage Hemorrhage(DP, tourniquet, surgery)

DISABILITY/EXPOSURE – LOC & GCS – Pupils – Completely undress patient – Prevent hypothermia

SECONDARY SURVEY VITAL SIGNS OBTAIN HISTORY OF PRESENT INJURY Report from EMS Mechanism of injury Blunt or penetrating Forces involved

Head and Maxillofacial – Inspect and palpate entire head and face – Re evaluate pupils, LOC an GCS – Inspect eyes for injury, acuity, contacts – Assess cranial nerves – Inspect ears and nose for CSF and blood – Inspect mouth for blood, loose teeth, foreign bodies, lacerations

CERVICAL SPINE AND NECK – Inspect for signs of blunt and penetrating injury, tracheal deviation, accessory muscle use – Palpate for tenderness, deformity, swelling, subcutaneous emphysema, tracheal deviation, pulses – Auscultate for bruit, stridor – Maintain c-spine stabilization

CHEST – Inspect anterior, lateral, and posterior chest wall for signs of blunt and penetrating injury, use of accessory muscles, bilateral movement – Auscultate breath and heart sounds – Palpate entire chest wall for evidence of blunt and penetrating injury, subcutaneous emphysema, tenderness, crepitation, flail segments – Percuss for dullness, hyperresonnance

ABDOMEN – Inspect anterior and posterior abdomen for signs of blunt and penetrating injury and internal bleeding – Palpate for tenderness, guarding, rebound, gravid uterus – Percuss for rebound, dullness, hyperressonnance

PELVIS, PERINEUM, RECTUM, VAGINA – Inspect for blunt and penetrating trauma – Palpate for pain and pelvic stability – Rectal for blood, sphincter tone, bowel wall integrity, prostate, bony fragments – Vagina for blood, lacerations

MUSCULOSKELETAL – Inspect for blunt or penetrating injury, contusions, lacerations, deformity, use and function, cap refill – Palpate for tenderness, crepitation, abnormal movement, sensation, peripheral pulses – Inspect and palpate thoracic and lumbar spine for blunt or penetrating trauma, tenderness, step off – Consider compartment syndrome

NEUROLOGIC – Reevaluate pupils, LOC, GCS – Evaluate extremities for function and sensation – Lateralizing and posturing – Maintain c-spine immoblization

STUDIES X-ray c-spine, AP chest, AP pelvis, extremities CT head, c-spine, chest, abd/pelvis U/S CBC, CMP, UA, ERSAP, ETOH, TROP, Coags