Pre -hospital stage

prepare resources and personnel

Set the role of every participant

Triage

Triage is a french word mean to sort

according to RPM 

R:respiratory rate less than 4 or more than 20

P: abscence of radial pulses

M:Mobility

Black or dead : no sign of life

Red : life threatening condition

Yellow : immobile

Green : mobile patient with minor injury

Primary survey and resuscitation (ABCDE)

A: Maintain adequate airway + cervical spine support

Talk to the patient if not speak means there is problem in airway

The cervical spine should be supported by

a. Cervical collar 

b. Two sand bags with fore head tapes or

c. In line traction (the head supported by person)

Then start suction, remove the vomitus and F.B

Then chin lift and jaw thrust → to prevent the tongue from falling back

Then insert pharyngeal airway (oral or nasal pharyngeal airway ) → to

prevent the tongue from falling back

Then intubation if no response → if the above measures failed

Then emergency cricothyroidotomy

Then emergency tracheostomy → the definitive treatment of airway

obstruction

B: Maintain adequate breathing + ventilation

Assess breathing by exposing the chest and neck for

Look

Chest movement (rate and depth of breathing)

Open wound in the chest

Bulging of the chest

Distended neck veins

Subcutaneous emphysema

Feel

Trachea deviated or not

The chest dull or hyperresonance

Crepitus

Listen

↓ Air entry

Muffled heart sound

C: Maintain circulation and control haemorrhage

 Assess for sign of haemodynamic instability by

Puls /BP/RR

Capillary refill

Temperature of the exterimities

Urine out put

Mental status

Look for external bleeding and controlled by pressure and bandaging

Identify the source of internal bleeding

 Management

Insert 2 wide bore cannulae and take blood for blood grouping and crossmatching

Hb, RBG, RFT with electrolytes

Give 2 L of Normal saline  or Ringer Lactate  in half hour

Control external bleeding by pressure and bandaging

D: Assessment of CNS dysfunction

Initial assessment of CNS dysfunction by

A= Alert

V = Reponse to voice

P = Response to pain

U = Unresponsive

Assess the pupil for ( normal/dilated/constricted/react to light or not)

E:Exposure with environment control

Adjuvant to primary survey

It include: completion of resuscitation

Pulse oxymetry for vital signs monitoring

chest ,lateral cervical and pelvic x-ray if portable 

urinary catheter after exclusion of urtheral injuries

NG tube if needed (after exclusion of fracture base of the skull)

Secondary survey

A.History

A: Allergies

M:Medications

P: Past medical history and pregnancy

L:Last Meal

E:Events leading to trauma

B.Examination

Examination of the whole body from head to toes

scalp: scalp laceration and haematoma

Eyes: conjectival haemorrhage - Raccoon eyes

Pupil: dilation and symmetry

Nose and ear: injuries + CSF or blood from the nose or the ear

Chest and CVS: for abnormalities

Abdomen: distension,tenderness,bowel sounds.

Urthera:bleeding +scrotal or perineal swelling 

Upper and lower extermities: for tenderness and deformity

Back: using log rolling technique for deformity and tenderness

Adjunct to secondary survey 

to do Fast scan or relevant imaging like CT scan.

Definitive Management

To call the specialty for definitive management.