Description
Learning Objectives
- List the ABCs of evaluating a trauma patient
- Demonstrate a head-to-toe review of a trauma patient
- Provide basic information about treatment of burns, bites, and stings
Primary Survey: The ABCs
Airway
The first step in the evaluation of trauma is airway assessment and protection.
- An airway is considered protected if the patient is conscious and speaking in a normal tone of voice.
- An airway is considered unprotected if there is an expanding hematoma or subcutaneous emphysema in the neck, noisy or “gurgly” breathing, or a Glasgow Coma Scale <8.
An airway should be secured before the situation becomes critical. In the field an airway can be secured by intubation or cricothyroidotomy. This is called a “definitive airway.” In the emergency department, it is best done by rapid sequence induction and orotracheal intubation, with monitoring of pulse oximetry. In the presence of a cervical spine injury, orotracheal intubation can still be done as long as the head is secured and in-line stabilization is maintained during the procedure. Another option in that setting is nasotracheal intubation over a fiberoptic bronchoscope. If severe maxillofacial injuries preclude the use of intubation or intubation is unsuccessful, cricothyroidotomy may become necessary.
In the pediatric patient population (age <12), tracheostomy is preferred over cricothyroidotomy due to the high risk of airway stenosis, as the cricoid is much smaller than in the adult.
Breathing
Breath sounds indicate satisfactory ventilation; absence or decrease of breath sounds may indicate a pneumothorax and/or hemothorax and necessitate chest tube placement. Pulse oximetry indicates satisfactory oxygenation; hypoxia may be secondary to airway compromise, pulmonary contusion, or neurological injury impairing respiratory drive and necessitate intubation. Measurement of CO2 (capnography) is also very useful.