Editing Trauma - initial assessment (section)

== Secondary survey ==
* Wait until primary survey is complete, resus is under way, and patient is improving/stable

==== History ====
** Allergies
** Meds
** Past hx/pregnancy
** Last meal
** Events leading up to injury
* MVA:
** ?seat-belt
** ?steering wheel deformation
** ?airbags
** ?direction of impact
** ?damage to car
** ?patient position in vehicle
** ?ejection

==== Examination ====
** Head
*** Scalp - ?lacerations, contusions, fractures
*** Eyes - VA, pupils, conjunctival haemorrhage, penetrating injury, contact lenses (remove before oedema occurs), lens dislocation, ocular entrapment)
** Maxfacs
*** Palpate all bony structures
*** Intra-oral exam
*** Assess soft tissues
*** These can all be managed later
*** Be wary of cribriform plate fractures
** C-spine/neck
*** Assume injury until cleared if maxillofacial or head trauma
*** Can use Nexus low-risk criteria to clear spine if
**** No focal neurologic deficit
**** No midline tenderness
**** GCS 15
**** No intoxication
**** No distracting injury
*** Inspect neck
**** Subcutaneous emphysema
**** Tracheal deviation
**** Laryngeal fracture
**** Palpate carotids - ?seatbelt mark or bruise
*** Do not explore wounds that penetrate platysma
*** Any active bleeding, expanding haematoma, arterial bruit or airway compromise requires operative evaluation
** Chest
*** Visual inspection and palpation
**** Entire chest cage
*** Auscultate high anterior (PTX) and low posterior (HTX)
*** Consider tamponade (distant heart sounds, low pulse pressure, tachycardia, distended neck veins)
** Abdo/pelvis
*** ?Pelvic fractures - ecchymosis over iliac wings, pubis, labia, scrotum
**** Pain on compression of pelvic ring
**** FAST or DPL if unexplained hypotension, neurologic injury, impaired sensorium, or any abdo findings
*** Seatbelt sign - often a/w mesenteric laceration or small bowel perforation or pancreatic injury
** Perineum/rectum/vagina
*** Contusions
*** Haematomas
*** Lacerations
*** Urethral bleeding
*** Rectal exam - blood, sphincter tone
*** Pregnancy test
** MSK
*** Palpate long bones
*** X-ray anything odd
*** Consider compartment syndrome
** Log roll
*** Each vertebra
*** Check for bruising
** Neurological
*** Motor and sensory evaluation of extremities
*** Re-evaluation of pupils and GCS
*** If deterioration neurologically - reassess oxygenation, adequacy of ventilation and perfusion of the brain
** Adjuncts
*** X-rays
*** CT
*** Contrast urography/angiography
*** TTE/TOE
*** Bronchoscopy
*** Oesophagoscopy
** Reassess need for transfer
[[Category:Trauma]]