The primary survey is the initial assessment and management of a trauma patient. It is conducted to detect and treat actual or imminent life threats and prevent complications from these injuries. A systematic approach using ABCDE is used. If a group of clinicians is assembled to perform the initial assessment, there will be multiple simultaneous activities occurring and resuscitation does not always proceed in a purely linear, sequential
fashion. Show
The primary survey of a trauma patient involves: Airway – with cervical spine control In single responder settings these may need to be addressed in a linear or sequential fashion; however, when a team is assembled, these elements may be addressed simultaneously. The term ‘survey’ is somewhat misleading in that it implies that only assessment is occurring; however, each phase requires simultaneous assessment for, and management of, any life threats detected. Control of exsanguinating external haemorrhageFailure to recognise and control large-volume external haemorrhage has been found to be a frequent occurrence in trauma resuscitation.7 Obvious large volume external blood loss must be managed as an immediate priority in the field and on arrival of the patient into the emergency department, with the aim being to control life-threatening external haemorrhage. Image used with permission from Department of Health, Victoria Airway with cervical spine protectionAn assessment of airway patency and stability should be performed during the primary survey and a plan for airway management instituted if required. Unless the patient is in cardiac arrest, immediate securing of the airway with endotracheal intubation is rarely required upon arrival of a major trauma patient. Life threatsThe following airway life threats must be assessed and managed:
Caution: Rapid-sequence intubation in patients with blunt or penetrating neck injuries carries the risk of total loss of airway patency upon administration of sedative and/or muscle relaxant medication.
Assess for airway stability
Assess for soiled airwayIf the patient has vomit, blood or excessive secretions on
their airway, these should be removed with suction. If there is excessive bleeding into the airway that cannot be removed with suction, it may be necessary to manage the patient on their side to allow drainage of blood from the mouth or nose, while maintaining C spine immobilisation. Patients can be placed on their side by performing a log-roll manoeuvre. Attempt simple airway manoeuvres if required
Care should be taken to not extend the cervical spine. Secure the airway if necessary (treat airway obstruction as a medical emergency)Consider intubation early if there are any signs of:
Maintain full spinal precautions if indicatedSuspect spinal injuries in all poly-trauma patients. Ensure a cervical collar, head blocks or in-line immobilisation is maintained throughout patient care. Breathing and ventilationLife threats
Oxygen administrationAdminister oxygen to achieve oxygen saturations between 94-98%. Assess the chestThe chest should be
fully exposed and inspected for any open wounds, bruising or deformity. The patient’s respiratory effort, respiratory rate and oxygen saturation should be noted.
Note: Finger thoracostomies require definitive ongoing management with an ICC unless the patient is positive pressure ventilated. Circulation with haemorrhage controlAssess circulation and perfusionCirculation assessment in major trauma focuses on detecting and managing shock, or reduced tissue perfusion. The most common cause of shock in a major trauma patient is hypovolaemic shock from blood loss.10 Blood loss may be external/visible, and therefore compressible, or internal/concealed and non-compressible. Assess:
Intravenous accessInsert two large-bore peripheral intravenous (IV) cannulas. If access is difficult consider a central or intraosseous insertion if the equipment/skills are available. If necessary, perform a FAST scanConsider the need for FAST (Focused Assessment with Sonography in Trauma) if it is available and staff are trained in its use. FAST is used primarily to detect pericardial and intraperitoneal blood in patients who are haemodynamically unstable. The FAST exam supplements physical examination for detecting intra-abdominal injury.11 If the patient is haemodynamically stable and shows no signs of significant internal bleeding then it may be delayed until the secondary survey. The FAST exam is reliable and repeatable. Control of exsanguinating external haemorrhageControl of external haemorrhage usually requires firm compression bandaging with combine pads applied over the
wounds, and firm crepe bandages applied circumferentially over the affected areas. Several layers may be required. Haemostatic dressings may be of use if available. Uncontrolled limb haemorrhage requires placement of an arterial tourniquet. This should not be removed until surgical haemorrhage control is achieved. Image used with permission from Department of Health, Victoria DisabilityAssess level of consciousness
Test blood sugar levelsEnsure that any alterations in level of consciousness are not related to a metabolic cause. Top of page Exposure and environmentIt is important to keep the patient normothermicBy the end of the primary survey the patient should be fully exposed to ensure no injuries posing an immediate life threat are missed. Which assessment takes priority when engaged in an emergency assessment of a patient?The ABCCS assessment (airway, breathing, circulation, consciousness, safety) is the first assessment you will do when you meet your patient. This assessment is repeated whenever you suspect or recognize that your patient's status has become, or is becoming, unstable.
Which are the top priorities when conducting a primary patient survey during the emergency assessment select all that apply?Airway and stabilization of the cervical spine are the top priorities when conducting a primary patient survey during the emergency assessment.. Clear the airway.. Protect the cervical spine.. Perform chest compressions.. Provide supplemental oxygen.. Which patient would the nurse assess first?Begin first with the patient who has the highest priority and progress to the patient who has the lowest priority. A nurse is performing a complete physical assessment of an adolescent.
Which nursing skill would be essential for the triage process in the emergency department?Abstract. Triage decision making is an essential skill for nurses. Through initial assessment, a nurse must be able to prioritize patient care on the basis of appropriate decision making.
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