Initial Assessment of Trauma Patient

Preparation & Triage - Trauma Tango Prep

• Pre-Arrival Notification: Essential for team readiness. Key info: patient demographics, Mechanism of Injury (MOI), vital signs, pre-hospital treatments.
• Trauma Team Activation: Triggered by pre-arrival data. Defined roles: surgeon, ED physician, anaesthesia, nurses.
• Universal Precautions: Mandatory PPE (gloves, gowns, masks, eye protection) for all staff.
• Equipment Readiness: Ensure airway tools, IV supplies, monitors, resuscitation drugs/fluids are accessible.
• Triage (In-hospital): Rapidly sort patients by injury severity and urgency.
  • 📌 MIST (pre-hospital): Mechanism, Injuries, Signs, Treatment.
  • ATMIST adds Age, Time.

⭐ The 'Golden Hour' refers to the critical period after trauma during which prompt medical treatment significantly improves patient outcomes.

Primary Survey (ABCDE) - ABCDE Lifeline Dance

📌 Systematic approach (ATLS) to identify & manage immediate life-threatening injuries.

• A: Airway with C-spine Protection

  • Assess patency; jaw thrust/chin lift. C-spine immobilization.
  • Definitive airway (e.g., intubation) if GCS < 8, apnea, aspiration risk.

• B: Breathing & Ventilation

  • Assess chest movement, RR, SpO2.
  • Identify & manage life-threatening chest injuries:
    • Tension Pneumothorax (needle decompression: 2nd ICS MCL / 5th ICS AAL).
    • Open Pneumothorax (3-sided dressing).
    • Massive Hemothorax (>1500ml initial / >200ml/hr).
    • Flail Chest.
    • Cardiac Tamponade.

• C: Circulation & Hemorrhage Control

  • Control external bleeding (direct pressure, tourniquet).
  • 2 large-bore IV cannulas (14-16G).
  • Assess for shock. Permissive hypotension (SBP 80-90 mmHg) if no TBI.
  • Fluids: Crystalloids (children: 20ml/kg bolus), blood products (1:1:1 ratio).

• D: Disability (Neurological Status)

  • GCS (Glasgow Coma Scale); GCS < 8 → intubate.
  • AVPU (Alert, Verbal, Pain, Unresponsive).
  • Pupils (size, reactivity). Focal deficits.

• E: Exposure & Environment

  • Completely expose patient. Log roll (inspect back).
  • Prevent hypothermia (warm blankets, warmed IV fluids).

⭐ The 'lethal triad' of trauma consists of hypothermia, acidosis, and coagulopathy; their early recognition and management are crucial.

Adjuncts & Resuscitation - Scan, Shock, Support

• Monitoring: ECG, SpO2, ETCO2.
• Imaging: X-rays (Chest AP, Pelvis AP; Lat C-spine if CT unavailable). eFAST for rapid internal bleed detection.
  • eFAST Views & Findings:

    View	Finding
    Pericardial	Effusion
    RUQ (Morison)	Hepatorenal fluid
    LUQ (Spleno)	Splenorenal fluid
    Pelvic	Free fluid
    Thoracic	Pneumo/Hemothorax

• Resuscitation: Large-bore IVs. Initial 1L crystalloid bolus. Permissive hypotension (SBP 80-90 mmHg) if no TBI, until bleed controlled.
• Massive Transfusion (MTP): For severe hemorrhage. Ratio PRBC:FFP:Platelets 1:1:1. Consider TXA.

⭐ In hypotensive trauma, suspect occult hemorrhage from abdomen/pelvis; early eFAST/CT is crucial.

Secondary Survey & Re-evaluation - Detective's Deep Dive

• Goal: Identify all injuries post-stabilization, once immediate life-threats are managed.
• History: 📌 AMPLE
  • Allergies
  • Medications
  • Past medical history (illnesses, surgeries)
  • Last meal (time)
  • Events/Environment related to injury
• Examination: Comprehensive, systematic head-to-toe, including all orifices. Log roll technique for spine/back assessment.
• Key Areas: Head, maxillofacial, C-spine, chest, abdomen, pelvis, perineum, musculoskeletal (extremities, peripheral neurovascular status).
• Neurological: Detailed assessment (GCS, pupils, motor/sensory function).

  ⭐ A normal initial Glasgow Coma Scale (GCS) score does not preclude subsequent neurological deterioration; therefore, frequent GCS re-assessment is critical in trauma patients, especially those with head injuries.

• Re-evaluation: Continuous monitoring of vital signs, GCS, urine output. Repeat primary/secondary surveys as needed.
• Definitive Care: Plan based on findings; specialist consultation or transfer to a higher center if injuries exceed local capabilities or resources.

High‑Yield Points - ⚡ Biggest Takeaways

• ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) with cervical spine control is paramount.
• Primary survey identifies and treats immediate life threats.
• Hemorrhage is the leading cause of preventable trauma death; control it early.
• GCS ≤ 8 indicates severe head injury and often requires intubation.
• Assume C-spine injury in blunt trauma, especially with altered sensorium or injury above clavicles.
• FAST scan, CXR, Pelvic X-ray are crucial adjuncts to primary survey.