Adjuncts to

Primary Survey
Abdul Hanan (09)
Haroon Akbar (14)
Shaheer Sultan (30)
Purpose of Adjuncts to the Primary Survey
● Early Detection
Adjuncts aid in early detection of life-threatening conditions.
● Enhanced Assessment
They enhance the assessment of airway, breathing, and
circulation.
● Improved Patient Outcomes
They contribute to improved patient outcomes and survival
rates.
Adjuncts of Primary Survey
01 02 03
Continuous ECG Monitoring Pulse Oximetry Ventilatory Rate,
Capnography and ABGs

04 05
Urinary and gastric catheters X-ray examinations and
diagnostic studies
ECG Findings in Different
Trauma
Condition ECG Finding
Tachycardia, AF,
Blunt Cardiac Injury PVCs, ST segment
changes
Pulseless Electrical
Cardiac Tamponade
Activity
Tension Pulseless Electrical
Pneumothorax Activity
Profound Pulseless Electrical
Hypovolemia Activity
 PULSE OXIMETRY
• Adjunct for monitoring oxygenation in
injured patients
• Most devices display pulse rate and
oxygen saturation continuously
• In addition, hemoglobin saturation
from the pulse oximeter should be
compared with value obtained from the
ABG analysis
• LIMIATIONS: It does not measure
partial pressure of oxygen or carbon
Ventilatory Rate, Capnography, and Arterial
Blood Gases
● They are used to monitor the adequacy of the
patient’s respirations.
● Ventilation can be monitored using end tidal
carbon dioxide levels.
● End tidal CO2 can be detected using
colorimetry, capnometry, or capnography
● End tidal CO2 can also be used for tight
control of ventilation to avoid
hypoventilation and hyperventilation, reflects
cardiac output and is used to predict return of
spontaneous circulation(ROSC) during CPR.
● ABGs: low pH and base excess levels
Urinary and Gastric Catheters
The placement of urinary and gastric catheters
occurs during or following the primary survey.
Urinary Catheters
 Urinary output is a sensitive indicator of
the patient’s volume status and reflects
renal perfusion.
 Monitoring of urinary output is best
accomplished by insertion of an indwelling
bladder catheter (urine specimen should be
submitted for routine laboratory analysis)
 Contraindication: Transurethral bladder
catheterization is contraindicated for
patients who may have urethral injury,
anatomic abnormalities (e.g., urethral
 Gastric Catheters
A gastric tube is indicated to decompress stomach distention, decrease the risk
of aspiration, and check for upper GI hemorrhage from trauma.

Contraindications: If a fracture of cribriform plate is known or suspected.

Blood in the gastric aspirate may indicate oropharyngeal (i.e. swallowed) blood,
traumatic insertion or actual injury to upper digestive tract.
 X-ray and diagnostic studies
• Do obtain essential diagnostic x-rays, even in
pregnant patients.
Importance of AP chest and AP pelvis films:
• Provide information to guide resuscitation efforts
of patients with blunt trauma.
• Chest x-ray can show potentially life-threatening
injuries that require further treatment or other
investigations.
• Pelvic films can show fractures of pelvis that may
 Use of FAST, eFAST and DPL:
• These are useful tools for quick detection of intra abdominal
blood, pneumothorax and hemothorax.
• DPL can be challenging to perform in patients who are
pregnant or have had prior laparotmies, obese patients
• Surgical consultation should be obtained.
• FAST can be compromised in obesity and intraluminal bowel
gas.
• Change of hemodynamic stability in patient with positive
finding of inta abdominal blood indicates need for surgical
intervention.
Diagnostic peritoneal lavage
DPL

Focused assessment
with sonography for
trauma FAST
This Photo by Unknown Author is licensed under CC BY