1. Assessment of the trauma patient
MASTER
© BASICS Education March 2019

2. Objectives Understand the principles of patient assessment
Conduct a Primary Survey <C>, Ac, B, C, D, E
Initiate essential life support procedures
Understand the need for reassessment
Be aware of the limitations of a Secondary Survey

3. Primary survey SAFETY FIRST <C> Catastrophic haemorrhage control
Ac Airway, with cervical spine control
B Breathing
C Circulation
D Disability of the CNS
E Exposure to examine
Should take no longer than 90 Seconds

4. Safety first Command Collective responsibility Dynamic
Operational may override the clinical
Collective responsibility
Safe systems of work
Dynamic
Multiple dimensions

5. Catastrophic haemorrhage control
Rapid, effective control by any means:
Direct pressure & ambulance dressing
Elevate
Haemostatic agents
Tourniquet
Torrential bleeding that will kill the casualty within minutes

6. Airway with cervical spine
Mechanism suggests C-Spine?
Unconscious casualty
Injury above the clavicle
Stabilise C spine
Manual in-line stabilisation
Neutral alignment if possible
Then assess airway
Airway overrides C-Spine when necessary to preserve life

7. Mechanism suggesting C-spine injury
Diving injuries
Falls
Assaults
Vehicle accident
Motor cyclists
Horse riders
etc…….

8. Recognise & clear the cause before you move on
Airway
Foreign bodies obstruction
Dentures
Food
Tissue swelling
Trauma
Allergy
Infection
Silence
Beware the fully obstructed airway
Snoring
Partial obstruction of the airway
Gurgling
Liquids i.e. blood / vomit
Stridor / crowing
Recognise & clear the cause before you move on

9. Oxygen High flow via a mask with reservoir bag BTS guidelines
10 to 15 lpm flow
Prime bag first
BTS guidelines
Cylinder capacity

10. Examination of the neck
W - Wounds
E - Emphysema
T - Trachea

11. Breathing Respiratory rate Look and feel for rise and fall of chest
Inspect chest for injuries (sides and back)
Palpate chest
Percuss chest
Auscultate chest
when possible due to noise etc.

12. Breathing examination
To examine breathing you have to expose the chest
Generally by cutting clothing

13. Breathing problems BL Blast lung A Airway obstruction
T Tension pneumothorax
O Open pneumothorax
M Massive haemothorax
F Flail segment
C Cardiac tamponade

14. Circulation Pulse - presence, rate and volume
Colour – especially pallor
Mental Status
level of consciousness
agitation
Capillary Refill Time (CRT)
BP if possible

15. Presence of pulses
Radial pulse present - likely to have sufficient blood pressure to perfuse the brain and kidneys

16. Causes of shock in trauma
Hypovolaemia
Tension pneumothorax
Spinal cord injury
Cardiac tamponade

17. Rapid transport

18. Disability AVPU Alert Verbal stimulus Painful stimulus Unresponsive
Pupils
Limbs x 4
Blood glucose

19. Environment
Temperature loss increases coagulopathy Poorer outcome with cold patients
Prevent heat loss

20. Secondary survey
Do not delay transportation for a detailed secondary survey
Rapid head to toe palpation
Identify gross deformity, pain and blood loss
S.A.M.P.L.E.
Signs and symptoms, Allergies, Medication, Past medical history, Last meal and Events leading to incident

21. On scene time
10 minutes
Regularly reassess patient

22. Entrapment Actual entrapment Relative entrapment
Assess immediately and reassess regularly
Consider management of Crush injury

23. Handover - MIST M - Mechanism of injury
I - Injuries sustained & suspected
S - Signs & Symptoms
T - Treatment given & needed

24. Patient assessment
Questions?

25. Patient assessment summary
Primary survey (90 seconds)
Catastrophic haemorrhage control
Airway with cervical spine control
Breathing with Oxygen
Circulation
Disability
Patient not trapped - 10 mins on scene time
Trapped patient - constantly reassess

26. Carnival UK Immediate Care Course