Primary Trauma Survey

What is physical trauma?

A traumatic injury is when an individual is suddenly hurt and, as a result, has serious injuries such as broken bones, traumatic brain injury, or bleeding. Traumatic injuries are medical emergencies that may pose a risk to their life or body. The individual must receive immediate medical attention to have the best chance to fully recover and minimize long-term effects.

There are three main types of traumatic injuries, and these are classified depending on how the injury occurs and the impact it has on the body:

• Blunt force: This is the most common traumatic injury and occurs when something hits the patient so hard that they sustain injuries.
• Deceleration: This occurs when an individual is in motion and suddenly stops.
• Penetrating: This occurs when something breaks through the skin, causing a wound.

Understanding how to evaluate trauma patients swiftly is crucial for healthcare practitioners. Primary Trauma Surveys can be conducted by a variety of health professionals, depending on the environment and circumstances. Examples include trauma team leaders, nurses, doctors, and respiratory therapists. The primary goal, particularly in major and adult trauma patients, is to identify and treat any life-threatening injuries as quickly as possible.

What is a Primary Trauma Survey?

The Primary Trauma Survey (PTS) is a critical first step in the trauma evaluation process. This identifies and manages the impending or actual life threats to the patient. Each part of the primary survey must be completed before progressing, and major trauma patients may require emergency surgery (Gwinnutt & Driscoll, 1996).

The common acronym for performing the Primary Trauma Survey is the ABCDE, with each letter representing an area of focus. The following are the important steps of the Primary Trauma Survey (Planas et al., 2017):

A: Airway assessment with cervical spine assessment

Airway protection is necessary for many trauma patients. To assess the patient's airway, establish if the patient can speak coherently; if they are, the airway is open. If obstruction is identified, performing a chin lift or jaw thrust is important. Throughout this process, the cervical spine must be immobilized and maintained in line to ensure cervical spine precautions. The cervical spine should be stabilized by manually maintaining the neck in a neutral position, in alignment with the body.

B: Breathing and ventilation

Typically, all trauma patients should receive supplemental oxygen. Firstly, it is important to inspect the patient, looking for signs of major chest trauma, such as tracheal deviation or significant chest wounds. Auscultation of both lungs should be conducted to identify asymmetric or decreased lung sounds. Any open chest wounds should be covered immediately with tape on three sides to prevent the entry of atmospheric air into the chest. If a flail chest and respiratory compromise are present, positive pressure ventilation should be provided.

C: Circulation with hemorrhage control

Adequate circulation is required for oxygenation to the brain and other vital organs; blood loss is the most common cause of shock in trauma patients. This is assessed by monitoring the level of responsiveness. This can be quickly assessed by mnemonic AVPU as follows

• A: Alert
• V: Respond to verbal stimuli
• P: Respond to painful stimuli
• U: Unresponsive to any stimuli

Obvious hemorrhaging should be controlled by direct pressure, pale or ashen extremities along with thready pulses in the carotids or femoral arteries are all concerns of hypovolemia. Any patient presenting with cold, pale extremities is classified as in shock until proven otherwise.

D: Disability

A rapid assessment of the patient's neurologic status is necessary on arrival, including checking the patient's conscious state and neurological signs. This is assessed using the Glasgow coma scale (GCS), pupil reaction and size, and lateralizing signs.

E: Exposure and environmental control

Finally, the patient should be completely undressed and exposed to ensure that no injuries are missed. Covering the patient after this and keeping them warm following exposure is crucial to limit the risk of hypothermia.

How does our Primary Trauma Survey template work?

Using the Primary Trauma Survey is straightforward and efficient. Follow these steps to use this template effectively:

Step 1: Download the template

You can access the Primary Trauma Survey template by clicking "Use a template. " This will allow you to edit the resource via the Carepatron app. To download a PDF copy, choose "Download."

Step 2: Preparation

Before a patient arrives, familiarize yourself with the template's content. Know where it is located (physically or digitally) so you can access it quickly. Review the ABCDE categories, action plans, and respective note sections so you're thoroughly versed in what's expected in each phase.

Step 3: Initiate the survey

When the patient arrives, begin the survey with the 'A' step and move systematically through each step, ensuring that each step is completed before progressing to the next. For each step, check the relevant items, perform the listed actions, and document your observations and interventions in the notes section afterward.

Step 4: Documentation and communication

Communicate survey findings and actions to the trauma team, ensuring everyone is aligned on the patient's status. Afterward, document all findings and interventions in the template for ongoing care and team handover.

Next steps

Completing the Primary Trauma Survey is a critical milestone in trauma care, but the journey does not stop there. Healthcare professionals move to the next phase to ensure comprehensive care. After the PTS, these steps are taken:

• Secondary survey: This is completed after stabilizing immediate life-threatening conditions. This more detailed examination covers the patient from head to toe, searching for any less apparent injuries the PTS might have missed, concurrent medical problems, constant blood pressure evaluation, and a complete history check (Gwinnutt & Driscoll, 1996).
• Definitive care: This focuses on providing specialized treatment after stabilizing the patient.  If the patient’s needs exceed the facility’s capacity, transfer to a higher-level trauma center is arranged based on the medical center's guidelines. Definitive treatment may involve advanced surgery, critical care, advanced trauma life support, and rehabilitation planning (American College of Surgeons, 2018).

What are the benefits of conducting this survey?

The Primary Trauma Survey is a critical first step in trauma care, offering a systematic way to identify and address life-threatening injuries immediately. Here are the key benefits of implementing this survey effectively:

Immediate identification of critical conditions

The PTS is designed to rapidly uncover serious threats to a patient's life, such as blocked airways, a head injury, major bleeding, or a flail chest. Recognizing this early on allows for immediate actions to stabilize the patient.

Setting treatment priorities

Knowing which problems to tackle in emergency care can significantly impact outcomes. The primary survey helps medical teams prioritize issues, immediately treating the most dangerous conditions.

Efficient use of hospital resources

By quickly assessing a patient's condition, the primary survey helps direct necessary resources — like blood products or surgery teams — where they are needed most, optimizing the use of valuable medical resources.

References

American College of Surgeons (2018). Advanced trauma life support: Student course manual. https://cirugia.facmed.unam.mx/wp-content/uploads/2018/07/Advanced-Trauma-Life-Support.pdf

Gwinnutt, C. L., & Driscoll, P. A. (1996). Advanced trauma life support. European Journal of Anaesthesiology, 13(2), 95-101. https://doi.org/10.1046/j.1365-2346.1996.00939.x

Planas, J. H., Waseem, M., & Sigmon, D. F. (2017). Trauma primary survey. https://www.ncbi.nlm.nih.gov/books/NBK430800/