Overview of Trauma Primary Survey
The primary survey is a quick process that medical professionals use to spot and respond to injuries that could be life-threatening. The main reasons why a person might die after an injury include difficulty breathing because the airway is blocked, failing to breathe properly, losing a lot of blood, and brain injuries. These are the main areas that doctors focus on during the primary survey. Is important to note that the following injuries, while not the only ones, may occur and can pose an immediate risk to your life:
- Blocked airway, where something is preventing air from moving in and out of your lungs as you breathe.
- Tension pneumothorax, a serious condition where air or gas builds up in the chest and can affect your heart and lungs.
- Heavy internal or external bleeding, where you lose a lot of blood either inside or outside of your body.
- Open pneumothorax, a condition where air flows into your chest through an opening in your chest wall.
- Flail chest, a potentially deadly condition where a portion of the rib cage breaks off and detaches from the rest of the chest wall.
- Cardiac tamponade, a serious condition where fluid builds up around the heart, making it pump less effectively.
- Intracranial bleed, bleeding inside the skull, which can increase pressure on the brain.
- Increased intracranial pressure, a condition where an accumulation of fluid or swelling inside the skull increases pressure on the brain.
Anatomy and Physiology of Trauma Primary Survey
Hypovolemic shock, usually seen in trauma situations, mainly happens due to severe bleeding. Certain changes in the body can be expected as a result. Things like the heart’s output of blood (“Cardiac index”), the space inside the veins (“venous capacitance”), blood pressure in the large veins near the heart (“central vein pressure”) and the pressure in blood vessels in the lungs (“pulmonary capillary wedge pressure”) all decrease. Moreover, the resistance to blood flow through the vessels throughout the body increases (“systemic vascular resistance”).
When dealing with shock where the blood vessels cannot maintain adequate blood supply (referred to as ‘distributive shock’), some signs are usually present. These may include very quick return of pink color to fingernails when pressed and released (called ‘flash capillary refill’) in less than a second, a strong pulse (“bounding pulses”), warm and dry skin on hands and feet, and a significant difference between the highest and lowest blood pressure readings (“widening of the pulse pressure”) that’s usually greater than 40 mmHg.
Why do People Need Trauma Primary Survey
If a person has been in a traumatic event, like a car accident for example, the first thing doctors will do is a primary survey. This is a quick check to find and then treat any life-threatening conditions. Sometimes, a patient might be upset or under the influence of alcohol or drugs, which can make this check difficult to do. If that’s the case, the doctor will give the patient medication to help them relax and might use a tool called an intubation tube to help keep their airway open. This will make sure the primary survey can be properly carried out.
When a Person Should Avoid Trauma Primary Survey
The primary trauma survey, a quick check performed by doctors to identify any serious injuries, can be done without restrictions. This is true even for patients who seem very stable but have suffered any type of injury, from something as small as a fall while standing, to wounds from sharp objects, which can appear insignificant. It’s important to conduct a primary trauma survey in these cases to make sure hidden injuries aren’t overlooked.
Equipment used for Trauma Primary Survey
The team dealing with injuries must make sure they’re wearing safety gear like gloves, masks, and gowns to keep themselves safe. They need a stethoscope to listen to the patient’s breathing from both sides; they should also clip a pulse oximeter onto the patient at this point. This tiny device measures how much oxygen is in the blood. Items needed for urgent treatment, such as large tubes for delivering fluids, heated saltwater solution, and special tubes should be within easy reach in the accident and emergency room.
Tools to help the patient breathe should also be immediately available. These may include a bag-mask device (a hand-held tool used to assist breathing), a tool to monitor the amount of carbon dioxide the patient is exhaling, a tray with the equipment needed to place a tube down the patient’s throat to help them breathe, and a surgical kit for creating a new airway.
If the patient’s lungs have collapsed (pneumothorax), there should be big, tube-like needles (angiocatheters) for a potential needle thoracostomy (a procedure that relieves pressure on the lungs) and a chest tube kit within easy reach.
The emergency room should be set up with a machine that can monitor the heart’s rhythm (EKG) and a portable X-ray machine for use after the first check to help identify any other problems. [11][12]
Who is needed to perform Trauma Primary Survey?
When someone gets seriously hurt, they are often taken to a hospital that has a trauma center. The trauma center has a special team ready to act quickly to check and treat the injured person. This team is made up of different medical experts who each have their own job. The team often includes:
- A team leader, who is a doctor and makes important decisions quickly.
- An anesthesiologist, a doctor who can help with pain or make you sleepy so that you don’t feel any discomfort.
- A trauma surgeon, a doctor who is specially trained to do surgery on injured people.
- A doctor from the emergency department.
- At least two nurses who assist the doctors and take care of the patient’s needs.
- A radiographer, a trained professional who will take pictures like X-rays so the doctors can see what’s going on inside your body.
- A scribe, who keeps track of everything that happens and writes it down.
Depending on the injury of the person, there could be other doctors needed like:
- A neurosurgeon, a doctor who operates on injuries to the brain and other parts of the nervous system.
- A thoracic surgeon, a specialist doctor who operates on organs located in the chest.
- A plastic surgeon, a doctor who can help repair or recreate certain parts of the body.
- A radiologist, another doctor who reviews scans and images of the body to help figure out what might be wrong.
These additional doctors aren’t always needed right away, but they can be called in quickly if necessary. All of these professionals work together to keep you safe and help you get better as quickly as possible.
Preparing for Trauma Primary Survey
Before the patient arrives, it’s important for the medical team to organize and prepare. This includes deciding who will do what, and making sure everyone is wearing protective clothing for safety. They’ll also check that all the necessary equipment is ready to go.
Some key areas of the hospital need to be informed about the patient and their condition. These include:
- The radiology department, who may need to do portable x-rays or a CT scan
- The intensive care unit, where the patient might need to be closely monitored
- The operating room, in case the patient needs surgery
By doing this, the team can ensure that everything is prepared to give the best possible care when the patient arrives.
How is Trauma Primary Survey performed
Doctors use a quick, step-by-step process called the primary trauma survey to check on patients after an accident or injury. They follow the acronym ABCDE, with each letter standing for a different area of focus. If anything unusual is found, it needs to be sorted out before moving on to the next step. This sequence helps ensure nothing serious gets missed. If a patient is acting out and it’s stopping a correct survey from being done, sedation and intubation may be used so that the medical personnel can proceed. One exception to this order would be if the patient has massive bleeding from a wound that can be treated right away.
Here’s what each letter stands for:
A: Airway and Cervical Spine Protection
The first step is to check if the patient’s airway is clear. If the patient can speak clearly, then they are responsive and their airway is open. If there’s an obstruction, it can be cleared with a ‘chin lift’ or ‘jaw thrust’. Also, any facial fractures, lacerations or foreign bodies need to be attended to. In this step, doctors also need to carefully maintain the alignment of the cervical spine to prevent any further injury.
B: Breathing and Ventilation
The next step is checking if the patient is breathing correctly, this involves looking for signs like abnormal movement, wounds or deviation of the trachea. Both lungs are also listened to, to check for decreased or uneven sounds. If a patient has a serious issue like a tension pneumothorax, they may require immediate intervention like needle decompression or tube thoracotomy. The patient should also be given supplemental oxygen.
C: Circulation and Hemorrhage Control
Medical staff next check the patient’s circulation in order to supply oxygen to the brain and other vital organs. Blood loss is the leading cause of shock in trauma patients and can be identified by looking at patient responsiveness, skin color, and the presence and quality of a pulse. Any bleeding should be controlled as quickly as possible. Even if blood pressure seems normal, there could still be a significant amount of blood loss, especially in children. It’s also possible to assess tissue perfusion by testing capillary refill time.
D: Disability (Neurological Status Assessment)
The patient’s neurological condition is rapidly assessed, which includes looking at patient’s conscious state and other neurological signs. This can be done using the Glasgow coma scale (GCS), checking pupil size and reaction, and any signs specific to one side of the body. If a patient’s GCS is less than 8, it implies that their airway reflexes may be compromised and that they may need a definitive airway.
E: Exposure and Environmental Control
Lastly, the patient should be fully undressed to make sure nothing gets missed, but then covered with warm blankets to prevent hypothermia.
With the primary survey complete, other tools can be used to look for life-threatening issues like abnormal heart rhythm, breathing problems, or fractures.
What Else Should I Know About Trauma Primary Survey?
Advanced trauma life-support care is a medical approach designed to make the assessment and treatment of trauma patients more consistent. It’s based on the understanding that time is absolutely crucial in evaluating and treating trauma cases. This system emphasizes the ‘golden hour’ – this is the time immediately after an injury occurs. Proper and timely treatment within this hour can save a patient’s life they might otherwise lose.
Medical professionals use something called a primary survey in this crucial period. This is a rapid evaluation to spot, identify and manage any injuries that could potentially be life-threatening. So, in cases of severe trauma, every second counts and getting the right medical attention promptly can make all the difference.
