Primary Survey in Trauma

assessment primary survey trauma Apr 16, 2025

Primary survey in trauma 🏥💉🩺

As the name suggests, the primary survey is the initial assessment made of a trauma patient. Like all assessments, a systematic approach provides structure and guidance to the assessment, ensuring vital details are not missed and assessment is undertaken in an organised and efficient manner. The goal of this assessment is to quickly determine any life threatening conditions or injuries, and identify and prioritise ongoing care needs.

Primary survey uses the <C>ABCDE approach - here it is in a nutshell! 🚑📋

Catastrophic haemorrhage🩸
🩸 Identify large volumes of external blood loss
💉 Respond accordingly: apply direct pressure//tourniquet/haemostatic dressings
🚫 Do not remove penetrating foreign objects
☠️ Threats to life include exsanguinating external haemorrhage, blunt/penetrating thoracic and/or abdominal injury

Airway and C spine management🌬️
👂 Assess for any airway obstruction: avoid C-spine manipulation unless cleared
🔊 Listen for upper airway noises
🩺 Assess for signs of potential aspiration or airway soiling: blood, vomit or excessive secretions and suction accordingly
🛠️ Utilise airway adjuncts as needed - oro/nasopharyngeal airways (contraindicated with head/base of skull suspected injuries)
🔒 Secure airway/intubate only if deemed necessary
🧠 All polytrauma patients should be treated with suspected spinal injuries until cleared, with cervical collar/head blocks/ in-line immobilisation maintained
☠️ Threats to life include airway obstruction, blunt/penetrating neck injuries

Breathing🌬️
👕 Expose the chest and inspect for open/penetrating wounds, make sure to check the patients back as well
📏 Assess for tracheal deviation
🔵 Asses for any bruising, abnormalities
🔄 Assess chest movements and breathing pattern
📉 Respiratory rate, effort and oxygen saturations
🤲 Palpate for tenderness/surgical emphysema
👂 Auscultate for bilateral air entry and any additional noises eg wheeze
💨 Administer oxygen, aim saturations 94-98%
☠️ Threats to life include tension pneumothorax, haemothorax, open pneumothorax, flail chest, tracheobronchial injury

Circulation❤️
🩸 Control of catastrophic haemorrhage should have already occurred - now its time to reassess perfusion and any further uncontrolled bleeding
💉 Establish large bore peripheral intravenous access: proceed to central access/intraosseous if unable to establish peripherally
🧬 Assess tissue perfusion and signs of shock: the most common cause of shock in trauma patients is hypovolaemic shock
🖥️ An eFAST scan will be performed to assess for tamponade, pneumo/haemothorax and intraperitoneal free fluid

Disability (neurological)🧠
👀 In initial AVPU assessment: a more detailed neurological assessment is performed in the secondary survey
🔦 Assess pupil size and responses
🩸 Measure blood glucose levels and treat accordingly
☠️ Threats to life include traumatic brain injury and intracranial pressure/haemorrhage

Exposure and environment🌡️
🧍‍♂️ The patient should be fully exposed to complete the primary survey to ensure no injuries are missed
🛏️ Regions of the body should be exposed individually, ensuring that privacy and dignity are maintained as much as possible
❄️ Exposure to ambient air contributes to hypothermia, regular temperature monitoring should be completed and attempts made to maintain normothermia

 

👥 In a team setting, multiple team members can work together to complete elements of the primary survey simultaneously to speed up the process and identify care priorities proficiently.

Build Knowledge
Improve Safety

 

References:

Trauma Victoria (20204) Early trauma care - primary survey. Victorian department of health Accessed from https://trauma.melbourneonline.com.au/specialist/early-trauma-care/primary-survey/

Queensland trauma education (2024). Performing the primary trauma survey. Accessed from https://qte.csds.qld.edu.au/resources/trauma-primary-survey-2/

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