TRAUMA EMERGENCIES

Overview
The initial trauma survey is a systematic and efficient process that is used to identify and treat life-
threatening injuries. The complete trauma survey is broken down into the Primary and Secondary
surveys and the A-I mnemonic guides us through the process.
Nursing Points
General
I. Systematic approach
A. A-I mnemonic.
1. A – Airway / Alertness
2. B – Breathing
3. C – Circulation
4. D – Disability
5. E – Exposure / Environmental Control
6. F – Full set of vitals / Family Presence
7. G – Get Resuscitation Adjuncts / Give Comfort Measures
8. H – History / Head-to-toe Assessment
9. I – Inspect Posterior Surfaces
B. Steps traditionally sequential
C. Identifies life-threatening problems before moving on
i.(get patient breathing before checking his broken arm)
Assessment
PRIMARY SURVEY
I. Airway / Alertness
A. Check Alertness – AVPU
1. Alert
2. Verbal
3. Pain
4. Unresponsive
B. Maintain C-Spine stabilization
1. Manual in-line stabilization
2. Immobilization (Cervical Collar)
C. Assess Airway
1. Inspect
2. Auscultate
3. Palpate
4. Assess definitive airway if present
a. Rise and fall of chest with assisted ventilations
b. Bilateral Breath Sounds
c. Verified Co2 detector or monitor
II. Breathing
A. Assess Breathing
1. Inspect
2. Auscultate
 3. Palpate
B. If not present – Determine need for airway adjuncts / Definitive airway
III. Circulation
A. Inspect
1. Identify life-threatenting hemmorhage
B. Auscultate
C. Palpate
1. CENTRAL PULSE (Carotid or Femoral)
IV. Disability
A. Assess and monitor GCS / LOC
V. Exposure / Environmental Control
A. Get patient naked and warm
SECONDARY SURVEY
I. Full set of vitals / Family presence
A. Blood Pressure (first one manual)
B. Pulse
C. Respirations
D. Temperature
E. Facilitate family persence
II. Get Resuscitation Adjuncts / Give Comfort Measures
A. LMNOP
1. Labs
2. Monitor cardiac rate and rhythm
3. Naso or orogastric tube
4. Oxygenation and ventilation
5. Pain assessment and management
III. History / Head-to-toe Assessment
A. History
1. Pre Hospital – MIST
a. MOI
b. Injuries
c. Signs and Symptoms (in the field)
d. Treatments (in the field)
2. Patient History – SAMPLE
a. Symptoms
b. Allergies
c. Medications
d. Past Medical Hx
e. Last Oral Intake
f. Events leading up to injury
B. Head-to-toe Assessment
1. Head and Face
2. Eyes
3. Ears
 4. Nose
5. Neck and C-spine
6. Chest
7. Abdomen / Flanks
8. Pelvis / Perineum
9. Extremeties
IV. Inspect Posterior Surfaces
A. Maintain C-Spine
B. Inspect
C. Palpate
D. Rectal Exam
Therapeutic Management
PRIMARY SURVEY
I. Airway
A. Maintain manual stabilization
1. Jaw thrust
2. Chin lift
B. Remove or suction loose objects and secretions
C. Insert NPA or OPA
D. Consider / anticipate definitive airway
E. Initiate C-Spine immobilization (C-Collar)
II. Breathing
A. Administer supplimental O2
B. Assist with BVM
C. Perform needle decompression / assist with chest tume as indicated
D. treat life-threatening pulmonary injuries
III. Circulation
A. Control life-threatening hemmorhage
1. (C)ABC
B. Begin CPR if no pulse
C. Insert 2 large bore IVs
1. Bilateral periphery (if possible)
2. Consider Intraosseous or central line if needed
D. Begin fluid resuscitation
IV. Disability
A. Maintain head midline
B. Keep bed flat or elevated 30-45 degrees
C. Consider Mannitol for changes in LOC and suspected increase in ICP
D. Decrease external stimuli
V. Exposure / Environmental Control
A. Assess hidden inuries
B. KEEP PATIENT WARM
1. Warm blankets
2. Ambient temperature
 3. Warm IV fluids
4. Forced air warmer
5. Radiant heat lamps
SECONDARY SURVEY
I. Full set of vitals / Family presence
A. Identify trends in vital signs
B. Chest trauma indications
1. Blood pressure in bilateral upper extremeties
2. Apical and radial pulses
C. Facilitate family persence
1. Enlist Social Work / Chaplaincy if available
II. Get Resuscitation Adjuncts / Give Comfort Measures
A. LMNOP
1. Labs
a. Type and Crossmatch / Rapid Transfusion Protocol
b. CBC
c. Chemistry
d. UA
e. Pregnancy Test
f. Ethanol
g. Tox Screen
h. Clotting studies
i. Serum Lactate / Base defecit
2. Monitor cardiac rate and rhythm
a. Watch for dysrythmias
b. Compare pulse to monitor rhythm
3. Naso or orogastric tube and Indwelling Urinary Catheter
4. Oxygenation and ventilation
a. Monitor pulse oxemetry
b. Monitor capnography
5. Pain assessment and management
a. Analgesics
b. Non-pharmacologic measures (if concious)
III. History / Head-to-toe Assessment
A. History
1. Pre Hospital – MIST (This information comes from EMS)
a. MOI
b. Injuries
c. Signs and Symptoms (in the field)
d. Treatments (in the field)
2. Patient History – SAMPLE (If the patient is awake… ask them! If not, find friends,
family, witnesses who can provide info)
a. Symptoms
b. Allergies
 c. Medications
d. Past Medical Hx
e. Last Oral Intake
f. Events leading up to injury
B. Head-to-toe Assessment
1. Head and Face
2. Eyes
3. Ears
4. Nose
5. Neck and C-spine
6. Chest
7. Abdomen / Flanks
8. Pelvis / Perineum
9. Extremeties
IV. Inspect Posterior Surfaces (Strip ’em and flip ’em!)
A. Maintain C-Spine
B. Inspect
C. Palpate
D. Rectal Exam
Nursing Concepts
I. Clinical Judgement
A. Systemic but flowing
B. Big Picture
II. Evidence Based Practice
A. ABCs vs (C)ABCs
B. TCCC – MARCH
1. Massive Hemorrhage
2. Airway
3. Respiration
4. Circulation
5. Head Injury / Hypothermia
III. Prioritization
A. What is the immedite life-threat?