Emergency Medicine – Trauma: By Kaushal Shah M.D.

Emergency Medicine – Trauma: By Kaushal Shah M.D.

Trauma comes in two basic varieties: blunt
trauma and penetrating trauma. Nonetheless, major trauma patients should always be approached
the same way: primary survey followed by a secondary survey. Don’t let the blood and
gore distract you. The primary survey entails a systematic assessment using ABCDE in order
to identify the true life-threatening injuries and initiate resuscitation. Then a detailed
head-to-toe exam should occur, which we call the secondary survey. A. Airway assessment. If blood, vomit or the
patient’s own saliva is blocking the airway (which often occurs in unconscious patients),
they will need suctioning and possibly intubation. B. Breathing. Examine the chest through inspection,
auscultation, and palpation. You are looking for life-threatening injuries. Decreased breath sounds, subcutaneous emphysema,
broken ribs, and tracheal deviation, are concerning for a tension pneumothorax, hemothorax, pulmonary
contusions, flail chest, and cardiac tamponade. C. Circulation. If the patient has a fast
heart rate or low blood pressure, suspect ongoing hemorrhage or blood loss, the number
one cause of preventable death in trauma. Bleeding is likely in one of four locations:
chest, abdomen, pelvis, or fractured long bones. Start IV fluids or blood transfusion
through two big intravenous lines. D. Disability. A basic neurologic assessment
will help you calculate a GCS or Glasgow Coma Scale. It evaluates Eye Opening, Verbal Response,
and Motor Response that is universally understood on a 15-point scale. E. Exposure. The patient should be completely
undressed to look for all injuries. Along with the secondary survey, the major
trauma patient often requires a chest x-ray, pelvis x-ray, and an ultrasound of the abdomen
called a FAST (focused assessment with sonography in trauma). This will allow identification
of blood loss from the most common sources. If blood loss exceeds the resuscitation with
fluid and blood, the patient will spiral into the classic trauma triad of death: acidosis,
coagulopathy, and hypothermia.

6 Replies to “Emergency Medicine – Trauma: By Kaushal Shah M.D.”

  1. I hope these aren't in order.. Don't you think a full examination/blood sweep would come before getting breath sounds ? 😬

  2. Nice but you have not talked about cervical spine protection or restrictions of neck movement especially in unconscious pt.

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