This is a step-by-step explanation of the management of the trauma patient. Unlike the medical patient, trauma relies less on history taking and much more on physical assessment and identification of life threats. The initial approach is still the same as for any other patient. We begin with the primary survey:
-Scene safety and BSI
-General impression: What is the patient’s position, are they visibly breathing, what is the skin colour/condition, and do they appear to be conscious?
-Life threats: In this case, is there obvious profound bleeding. We are not concerned with superficial wounds, or deformities. We want to identify immediate life threatening hemorrhage and deal with it right now.
-Cervical spine precautions: In general, it is advisable to initiate manual cervical spine stabilization until the need for SMR can be established or ruled out.
-Airway: Is it patent, and can the patient maintain it themselves? Do you need suction? Is an adjunct required?
-Breathing: Is the patient breathing? Is the rate and depth/respiratory effort sufficient to support life, or do we need to assist with supplemental oxygen or PPV?
-Circulation: Assess radial and carotid pulses for rate, rhythm, and strength, as well as capillary refill time.
-Disability: Determine the patient’s orientation to person, place, time, and events.
-Exposure: Depending upon the mechanism of injury we will either perform a focused examination of an isolated injury, or a rapid trauma survey (head to toe assessment, and removal of clothing) looking for immediate life threats and addressing them as they are found.
-Determine transportation priority: Are we going to extricate and transport immediately or treat on scene first? If we are going to utilize air transport we want to get that started now. Follow local trauma protocols regarding receiving facility.
-Establish baseline vitals.
-In the case of major trauma, we want to establish 2 large bore IV sites at this point.
-Obtain Past medical history, medications, allergies, and last oral intake.
-Perform a detailed secondary assessment from head to toe enroute to the ED, and treat additional, less severe injuries, and consider analgesic.
Any time there is an intervention performed or a change in patient status, repeat primary assessment and address life threats. Update the receiving facility accordingly.
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