Initial

Assessment
and
management

Dr. Yunus, Sp. BS

CONCEPTS OF INITIAL ASSESSMENT

Preparation
Triage
Primary survey ( ABCDEs

Resuscitation
Adjuncts to

primary survey and resuscitation

Secondary survey ( head-to-toe evaluation and history )
Adjuncts to the secondary survey
Continued postresuscitation monitoring and reevaluation
Definitive care

 Repeat

primary and secondary survey when finding

any deterioration in the patients status

Primary survey and resuscitation are done

simultaneously

PREPARATION
Prehospital
Airway

maintenance
Control of external bleeding & shock
Immobilization of the patient
Communication with receiving hospital & immediate transport
to the closest, appropriate facility
History taking ( include events )
Inhospital
Advanced planning ( especially massive casualty )
Equipment & personnel
Communicable disease protection
Transfer agreements

PRIMARY SURVEY
Adult

/ Pediatric priorities same

Identified the life-threatening conditions and simultaneously
managed
A: Airway maintenance with cervical spine protection
B: Breathing and ventilation
C: Circulation with hemorrhage control
D: Disability ( Neurologic status )
E: Exposure / Environmental control: Undress the patient &
prevent hypothermia

PRIMARY SURVEY
Airway Maintenance with

Cervical Spine Protection

Oral foreign bodies, facial, mandibular, or tracheal / laryngeal
fractures may result in airway obstruction
Assume

C-spine injury

Multisystem

trauma
Altered level of consciousness
Blunt injury above clavicle

PRIMARY SURVEY
Breathing

and Ventilation
Airway patency adequate breathing & ventilation
injury that may acutely impair ventilation
1.

Tension pneumothorax
2. Flail chest with pulmonary contusion
3. Massive hemothorax
4. Open pneumothorax
above problems need to be identified in the primary survey and managed

PRIMARY SURVEY
Circulation

with Hemorrhage Control

Assess blood volume and cardiac output
level of

consciousness
skin color
Pulse
Bleeding

control: direct manual pressure on the wound

PRIMARY SURVEY
Disability (

Neurologic Evaluation )
Level of consciousness
A. Alert
V.

Response to voice
P. Response to pain
U. Unresponsive
Pupils

PRIMARY SURVEY
Exposure/Environmental

Control
Undress patient completely
Protect from hypothermia

RESUSCITATION
Protect/Secure airway

& protect C-spine

Breathing/Ventilation/Oxygenation
Shock therapy :
At last two large - caliber IV line
Crystalloid solution ( Ringers lactate 2~3 litter)
Type-specific blood
surgical intervention
Protect from Hypothermia : 39oC warm IV fluid
Urinary/gastric catheters unless contraindication

ADJUNCTS TO PRIMARY SURVEY AND

RESUSCITATION
Monitor:
Respiratory

rate
Pulse oximetry
ECG & BP monitor
Temperature
urine output

X-RAY AND DIAGNOSTIC STUDIES

Cant

delay or interrupt the primary survey and resuscitation

Trauma series ( portable X-ray ): CXR, C-spine/ lateral view,
pelvic AP view
A negative or inadequate c-spine x-ray cant exclude cervical
spinal injury
Sonography / DPL (diagnostic peritoneal lavage )

BEFORE SECONDARY SURVEY

Complete primary survey
Establish resuscitation
Normalization of vital functions

SECONDARY SURVEY
History taking
Complete neurologic exam.
Head-to-toe evaluation
Roentgenograms
Tubes and fingers in every orifice
Re-evaluation

SECONDARY SURVEY
History

A.
M.
P.
L.
E.

Allergies
Medications currently used
Past illness / pregnancy
Last meal
Events / Environment related to injury

HISTORY
Mechanisms of injury
Blunt
Automobile collisions

Seat belt usage

Direction of impact
Ejection of passenger form

Burns and Cold injury

Inhalation injury and CO.
Hazardous environment
Penetrate
Energy transfer factor
Velocity and
Trajectory
Distance

the vehicle

intoxication in fire field

caliber of bullet

REEVALUATION
New findings / deterioration / improvement
High index of suspicion ==> early diagnosis &

management

Continuous monitoring
Pain relief

DEFINITIVE CARE

Trauma center
Closest appropriate hospital

20

Terima