Editing Trauma - initial assessment (section)

== Primary survey ==

* <blockquote>Goal: is the patient shocked, and what is the cause of shock?</blockquote>
* Rapid primary survey with simultaneous initial resus, followed by detailed secondary survey, then definitive care
** Introduce yourself
** Ask the patient's name
** Ask what happened
** If appropriate answers - ABCD is ok

==== '''Airway maintenance, restriction of C-spine''' ====
** Keep neck still for now - can clear C-spine later
** Oxygen
** Inspect for foreign bodies/facial and neck fractures
** Clear airway
** Suction
** Open/secure airway
*** Jaw thrust/chin lift
*** If GCS<8, early intubation, with exact timing depending on other factors including sats
**** Or surgical airway if intubation can't happen for whatever reason
*** If unconscious with no gag reflex, NPA can be helpful

==== '''Breathing and ventilation (adequate gas exchange)''' ====
** Expose neck and chest
** Inspect neck: tracheal deviation and jugular venous distension and absent unilateral breath sounds = tension PTX -> needle decompression and chest tube
** Inspect chest: injuries and symmetrical rise
** Auscultate lungs
** Specifically exclude and immediately treat
*** tension PTX
*** Massive haemothorax
*** Open PTX
*** Tracheal/bronchial injuries
** Give oxygen and monitor oximetry

==== '''Circulation with haemorrhage control''' ====
** Hypotension is due to blood loss until proven otherwise
*** Can look at pulse pressure
** Level of consciousness
** Skin perfusion
** Pulse
** If bleeding externally
*** Direct pressure
*** Tourniquet if direct pressure not working and life is in danger
** Internal bleeding
*** Chest
*** Abdomen - FAST scan
*** Retroperitoneum
*** Pelvis
**** Needs stabilisation device?
*** Long bones
** Get vascular access
*** FBE, UEC, LFT, COAG, bHCG, ?TROP, XM/G+H, VBG
** 1L IV crystalloid if any sign of shock
*** If unresponsive, blood
** IV tranexamic acid if uncontrollable bleeding

==== '''Disability (neurologic)''' ====
** GCS
*** If low, immediately re-evaluate ABC
*** Assume CNS injury until proven otherwise
*** Consider drugs/alcohol
** Pupils

==== '''Exposure/environmental control''' ====
** Completely undress patient then warm

==== '''Adjuncts to primary survey''' ====
** ECG
** ?IDC
*** Need to examine perineum/urethral meatus
*** If concern for urethral injury, need retrograde urethrogram prior to IDC
** X-rays
*** Even in pregnant patients
*** Don’t interrupt resus
** ?NGT
** FAST/DPL

* Obesity