Trauma: Hx and PE (Adults)

In accordance with the principles of advanced For the EMS providers, (prior to patient’s A focused history should provide
trauma life support, injured patients are assessed arrival in hospital), they should provide the important information such as:
and treated based on three concepts: following to the receiving ED:
-Circumstances of injury
1) Treat the greatest threat to life first. 1) mechanism of trauma -Ingestion of intoxicants
2) The lack of definitive diagnosis 2) suspected injuries -Pre-existing medical conditions
3) vital signs -Medications
should never impede the application
of an indicated treatment. 4) clinical sx It may be obtained from the:
3) A detailed history is not essential to 5) examination findings  Patient or Family members
begin the evaluation of a patient 6) treatments provided  Witnesses or Prehospital
with acute injuries. providers

PRIMARY SURVEY

A
1. Determine airway patency:
Airway a. Foreign bodies
b. Maxillofacial fractures
2. Jaw thrust/chin lift
3. Endotracheal intubation, if:
a. Depressed LOC
b. Inability to protect airway
4. If the patient is obtunded, assume a
cervical spine injury until proven
otherwise.
a. Maintain spinal immobilization
during resuscitation.

B
Breathing Inspection of thorax and neck: Consider immediate needle thoracostomy for
 Open chest wounds suspected tension pneumothorax.
 Abnormal chest wall motion (flail chest)
Consider tube thoracostomy for suspected
Palpate:
hemopneumothorax.
 Deviated trachea (tension
pneumothorax)
 Crepitus (pneumothorax)
Auscultate:
 Absence/asymmetric of breath sounds
on either side of chest

C
Circulation Assess for blood volume status: Skin color,
capillary refill, central/peripheral pulses, & BP.

IVF for initial resuscitation: LR (crystalloid)

IV placement:
 2 large bore IV catheters
Blood transfusion (if indicated):
 type O blood: after rapid infusion with
no marked improvement
 PRBC/Plasma: clotting and platelet
function
 Perform screening neurologic and

D
Disability mental status examination, assessing:
 Pupil size and reactivity
 Limb strength & movement,
grip strength
 Orientation, GCS score
Consider measurement of capillary
blood glucose level in patients with
altered mental status

E
Exposure Completely disrobe patient and inspect
for burns and toxic exposures.

Logroll patient, maintaining neutral

position and in-line neck stabilization, to
inspect and palpate…
 Thoracic spine
 Flank
 Back
 buttocks

SECONDARY SURVEY IMAGING AND LABORATORY

TESTING
Standard radiographic imaging:
- cervical spine
- chest, and pelvic radiographs
Extended FAST examination

In obtunded patients or those with multisystem

trauma, consider imaging of the entire spine if the
mechanism of injury warrants it.

Routine laboratory studies often include:

- blood type and screen; hgb level
- urine dipstick testing for blood
- blood ethanol level
- pregnancy test for women of childbearing
age
- capillary blood glucose level in pts with
altered mental status
- >55 y/o: ECG, markers for cardiac ischemia
TRAUMA TO EXTREMITIES
Note:

In the absence of hard signs, determine the ankle-brachial

index for any injured extremity along with the nonaffected
extremity for comparison.

RADIOLOGIC EXAMINATIONS:

1) Plain Radiographs
 anteroposterior and lateral radiographs of extremities
with suspected injury/fracture
 Oblique views for suspected retained foreign body
 For shotgun or blast injuries, obtain radiographs of the
extremity and joint distal to the injury
2) CT angiography
 Primary diagnostic study for the evaluation of vascular
injuries to the extremities
 Also assists in the evaluation of extravascular injuries
such as fractures, foreign objects, or joint involvement
 Noninvasive; less expensive compared to catheter
angiography
3) Ultrasonography
 To identify vascular injury

TREATMENT:

1) Control of bleeding
- direct pressure, pressure dressing, or a tourniquet
2) Arterial injury
- CT angiography
- Positive >>> immediate vascular surgery consult
3) Fractures and joint injuries
- Surgical debridement
- IV antibiotics
4) Wound management
5) Wound closure
6) Soft tissue foreign bodies
- Detection using plain radiographs
7) Follow-up