Ministry of Health

NZ Government

    
 ©Copyright
 Published: 11/10/2007

Primary Survey for Trauma

The primary survey is achieved through parallel tasking. Knowing your role makes this possible.

Airway (with C-spine control)

1. Assess the airway and determine its adequacy
2. Create or maintain an airway by
    a. Looking with suction
    b. Chin lift or jaw thrust
    c. Naso/Oropharyngeal airway
    d. Orotracheal intubation
    e. Cricothyroidotomy
3. Recognise the potential for cervical spine injury and maintain the
     spine in a safe neutral position until clinical examination and
     radiological findings exclude injury.

Indications for intubation
    § Airway or breathing compromise (present or predicted)
    § Unprotected airway
    § GCS < 9
    § Combative
    § Uncooperative patients (M5 or less) requiring CT, aortography etc.

Breathing

1. Administer high flow oxygen
2. Assess the chest by
    a. Inspection
    b. Palpation and feeling for the trachea
    c. Percussion
    d. Auscultation
3. Recognise and treat:
    a. tension pneumothorax
    b. massive haemothorax
    c. flail chest
    d. sucking chest wounds
    e. pericardial tamponade

Circulation

Assess circulation by
    a. Looking for external haemorrhage
    b. Observing skin colour, temperature and capillary refill
    c. Feeling the pulse
    d. Taking the blood pressure
    e. Neck veins

The patient with cold pale peripheries has shock until proved otherwise

1. Arrest external haemorrhage by local pressure
2. Insert at least two large bore (> 16g) IV cannulae
    a. Venous cut down or femoral vein Vascath if lines not possible
3. Take the trauma bloods (FBC, relevant biochemistry, ethanol, cross match, and pregnancy test in females of childbearing age).
4. Begin infusion with 1-2 litres of normal saline in adults.
5. Monitor the patient with an ECG monitor and a pulse oximeter

All fluids should be warmed (up to 39⁰C).
In massive haemorrhage use the Level 1 infuser.
Exsanguinating patients get group O blood ASAP

Disability

1. GCS
    a. Are the eyes open ( 'no' means E3 or less)
    b. Talk to the patient
    c. Use painful stimulus to finger or toe if required
        - (A sternal rub has difficulty distinguishing M3, 4 and 5 )
2. Assess the pupillary size and response
3. Examine for lateralising signs (e.g. differing motor scores on each side)
     and signs of cord injury

Exposure/Environmental control

1. Expose the patient so that an adequate complete examination can be
     performed.
2. Prevent the patient becoming hypothermic, measure their temperature

Last updated on 11/10/2007