Scribd Logo
Upload

Welcome to Scribd!

  • 21 views

    Primary Survey Real

    Uploaded by

    Laraib Kanwal

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Primary Survey Real

    Uploaded by

    Laraib Kanwal
    21 views21 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views21 pages

    Primary Survey Real

    Uploaded by

    Laraib Kanwal

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    PRIMARY SURVEY

    ABDUM MUNEEB
    FATIMA FARRUKH
    IQRA MEHMOOD
    LEARNING OBJECTIVES:
    • WHAT IS PRIMARY SURVEY?
    • OBJECTIVES OF PRIMARY SURVEY
    • COMPONENTS OF PRIMARY SURVEY
    ATLS:
    The advanced trauma life support (ATLS) protocols as outlined by the American
    College of Surgeons (ACS) dictate the initial management and resuscitation of all
    trauma patients.
    ATLS WAY OF TRAUMA MANAGEMENT :

    • Identification of severe trauma


    • Primary survey
    • Adjuncts to primary survey and resuscitation.
    • Secondary survey
    • Adjuncts to Secondary survey .
    • Continously post resuscitation monitoring and re evaluation.
    PRIMARY SURVEY:

    • Primary surveys are preliminary assessments of


    patients, aiming to identify quickly and
    systematically and take action on any life-
    threatening issue. Primary surveys should be
    conducted in no more than 2-5 minutes.
    • Concept of golden hour:
    • Adequate management of trauma with in first hour
    of incident that will prevent death.
    OBJECTIVES:

    • The primary survey is designed to assess and treat life-threatening injuries


    rapidly. The leading causes of death in trauma patients are airway obstruction,
    respiratory failure, hemorrhagic shock, and brain injury. Therefore, these are the
    areas targeted by the primary survey.
    COMPONENTS OF PRIMARY SURVEY:

    1. c : External hemorrhage
    2. A: Airway maintenance with cervical
    spine protection
    3. B: Breathing and ventilation
    4. C: Circulation and hemorrhagic
    control
    5. D: Disability/ Neurological status
    6. E: Exposure/ Environmental control
    C: EXSANGUINATING EXTERNAL
    HAEMORRHAGE:
    • Most of these injuries are due to gunshot wounds or blasts.
    • Bleeding must be controlled immediately by the application of packs and
    pressure directly onto the bleeding wound and proximal artery.
    • Failure to control bleeding in the limb by direct pressure with surgical dressings
    should be followed by the application of a tourniquet proximal to the wound.
    A : AIRWAY AND C SPINE PROTECTION
    • Evaluation:
    • Ask name if patient is conscious
    • If unconscious, protocol is activated
    • Management:
    • Before any manipulation to the airway, stabilize a spine.
    • Rigid cervical collar or placing sandbags on both sides of the
    patient’s forehead taped across the bags to the backboard in the
    line of spinal head.
    • Open the mouth with chin lift or jaw thrust maneuver to ensure
    airway patency while maintaining the in line immobilization of
    cervical spine.
    • Unconscious patient has tendency of falling
    back of tongue. So oropharyngeal airway is
    passed to keep airway patent.
    • If endotracheal intubation is impossible e.g.
    in severe facial trauma),
    • The next step is surgical airway in the form
    of cricothyroidotomy.
    SHIFTING THE PATIENT:

    Immobilize the whole body on a


    long spinal board.
    • Use log roll technique while
    shifting the patient
    B: BREATHING AND VENTILATION:
    • Once a secure airway is maintained, adequate oxygenation
    and ventilation must be ensured.
    • All injured patients should receive supplemental oxygen
    and be monitored by pulse oximetry.
    • The aim is to identify and treat the six life threatening
    conditions listed below:
    • Airway obstruction
    • Tension pneumothorax
    • Massive hemothorax
    • Open pneumothorax
    • Flail chest
    1. Cardiac tamponade
    Evaluation:
    Inspect for symmetrical chest movements and look for signs of
    penetrating and blunt trauma.
    • Palpate the trachea for deviation.
    • Palpate the chest wall
    • Percussion: A dull percussion note with absent breath sounds indicate
    hemothorax and hyper-resonant percussion note with absent breath
    sounds is an indicator of massive pneumothorax.
    • Auscultate the chest
    • Neck is evaluated for engorged veins.
    MANAGEMENT:

    Attach Pulse oximeter to assess the oxygen saturation.


    Administer 100% oxygen to all trauma patients.
    • Tension Pneumothorax is managed with needle decompression in the
    second intercostal space. (Air is under pressure and resides at the highest
    place of apex).
    • Massive Hemothorax requires vigorous circulatory support followed by
    chest intubations.
    MANAGEMENT

    Penetrating chest trauma (open pneumothorax) is managed by partial occlusive


    dressings of wound
    • Flail chest is managed conservatively with good analgesia.
    • For cardiac Tamponade; Needle periocardiocentesis may be life saving in the
    short term; thoracotomy and repair is required for definitive management.
    C: CIRCULATION AND HEMORRHAGE CONTROL:

    Evaluation:
    Assess the pulse and blood pressure of the patient.
    Look for visible bleeding.
    Look for signs of injury
    Look for any injury of pelvis and long bones.
    Hydration status and skin color is checked.
    Focused abdominal Sonography for trauma (FAST) is
    performed to rule out the abdominal concealed hemorrhage.
    • Perform Digital rectal examination.
    •Management:
    • The objective is resuscitation with simultaneous control of the
    hemorrhage.
    • Control the external hemorrhage direct pressure either manual
    or with the help of dressing pads.
    Two wide bore cannulas are inserted
    • Warm Crystalloids solution i.e. lactate ringer is infused to every
    trauma patient,
    MANAGEMENT
    • One gram Tranexamic acid is given intravenously over 10 minutes, followed by a
    further 1-g over 8 hour (Indication: significant hemorrhage, systolic blood
    pressure o <110 mmHg or a pulse of over 110 per minute. ideally within the first
    hour from injury,)
    • Nasogastric tube and urinary catheter
    • In case of hemodynamic instability, lapratomy is warranted to control the
    bleeding site and save the patient(Damage Control Laparotomy).
    • In penetrating injuries of the neck where venous injuries are suspected put the
    patient in the Trendelenburg position; (head down) to prevent air emboli.
    DISABILITY:

    Assess level of consciousness (Glasgow


    Coma Scale).

    Assess pupils (size, reactivity).


    • Look for lateralizing signs like
    hemiparesis etc.
    E: EXPOSURE/ENVIRONMENT
    CONTROL:
    Temperature of the emergency room is maintained before uncovering the patient.
    • Undress the patient completely for thorough examination.
    • Examination is carried out both from front and back of the body for any signs of
    injury.
    • Warm blankets are used to cover the patients after examination.
    • Warm crystalloids solutions are used for resuscitation.
    • It’s mandatory to avoid hypothermia of the trauma patients as it can leads to
    worsening of coagulopathy and further hemorrhage.

    You might also like