Primary Trauma Survey

What is trauma in the physical sense?

In our everyday lives, the term "trauma" might get tossed around in various contexts, but when it comes to the physical sense, its definition becomes significantly more focused. Trauma, in the realm of healthcare, is the response to a severe or potentially severe injury or injuries that have been directly inflicted upon the body. Whether it’s the result of a car accident, a fall, or an assault, trauma demands immediate and focused assessment and intervention to save lives and minimize long-term effects.

For healthcare practitioners, particularly those involved in emergency medicine, understanding how to swiftly and effectively evaluate trauma patients is crucial.

A trauma patient is someone who has sustained significant injuries that may pose an immediate risk to their life or body. These injuries can manifest from a variety of incidents, including vehicular accidents, physical assaults, falls, and more. In the healthcare setting, these patients require prompt and precise assessments to manage any life-threatening injuries they may have sustained. The primary goal in the care of patients particularly major and adult trauma patients is to identify and treat any life-threatening injuries as quickly as possible.

What can cause physical trauma?

As healthcare practitioners, we are well aware of the many ways that physical trauma can enter emergency rooms – each case is as unique as the individual enduring it. Understanding these causes is critical to be more prepared for different scenarios. The most common causes of physical trauma include:

• Vehicle-related collisions: One of the most common sources of trauma, collisions involving cars, motorcycles, bicycles, and pedestrians can lead to multiple, severe injuries. The impact and mechanism of the accident play significant roles in the types of injuries sustained.
• Falls: An all-too-frequent cause of trauma, falls can range from simple slips at home to high-impact falls from considerable heights in industrial settings. The elderly, in particular, are at high risk for serious injury from falls.
• Violence: Assaults, gunshot wounds, stabbings, and other forms of interpersonal violence can result in penetrating or blunt trauma – or both, demanding quick and precise intervention.
• Sports injuries: Athletic activities, both professional and recreational, can lead to significant trauma, especially in contact sports or due to high-risk maneuvers in solo sports.
• Workplace accidents: These can be highly varied and industry-specific, such as machinery-related injuries in manufacturing, or falls and crush injuries in construction.
• Explosions and blast injuries: While perhaps less common in civilian settings, explosions can lead to a complex mix of burn, blunt, and penetrating trauma, often seen in military or terrorist events.
• Natural disasters: Earthquakes, tornadoes, and other catastrophic events can cause blunt, penetrating, and crush injuries, often to many people at once, taxing the healthcare system’s capacity to respond.

What are the dangers of physical trauma?

Physical trauma, a reality encountered in emergency rooms and trauma centers, brings with it a host of dangers. Treating trauma patients can be complex and specialized, with each case presenting its own set of challenges. Here, we dive into the dangers associated with physical trauma so we can better address and mitigate the risks that come with them:

• Compromised airway: One of the most pressing concerns following trauma is ensuring that the patient has an open and functional airway. Obstructions, facial fractures, or neck injuries can quickly lead to suffocation if not promptly addressed.
• Breathing difficulties: Trauma patients often face difficulties with breathing due to punctured lungs (pneumothorax), rib fractures, or contusions that can dramatically reduce lung function, leading to inadequate oxygenation of the blood.
• Circulatory collapse: Significant blood loss from internal or external injuries can precipitate shock, characterized by a rapid pulse, low blood pressure, and eventual organ failure if circulation is not restored effectively.

Assessing physical trauma

The impact of physical trauma, whether resulting from a car crash, serious fall, or other significant incident, leaves little to no room for guesswork. It is important for healthcare providers and first responders to act quickly and decisively to save lives. The ABCDE principle serves exactly this function:

• Airway: The very first thing healthcare practitioners must determine is whether the patient has a clear and intact airway. If the airway is blocked due to injury, unconsciousness, or debris, the patient may not be getting the critical oxygen necessary to keep vital organs functioning.
• Breathing: Once the airway is established, the healthcare provider then checks the patient's breathing, looking for signs of issues like collapsed lung(s), chest wall instability, or other respiratory issues that can interfere with oxygen supply.
• Circulation: The next step is to assess circulation, looking for signs of dangerous blood loss. This can mean external bleeding that is visible, but also internal bleeding, that while not seen, can be just as deadly.
• Disability: Checking the patient's neurological status is crucial to identify potential brain injury, stroke, or other neurological conditions.
• Exposure: Lastly, the patient's clothes are removed to facilitate a full-body physical examination, ensuring no missed injuries. Providers must simultaneously ensure that the patient is kept warm to prevent hypothermia - a potential secondary complication that could further complicate the patient's condition.

What is a Primary Trauma Survey?

In the fast-paced, often chaotic world of the emergency department, where seconds can mean the difference between life and death, the Primary Trauma Survey is a critical first step in the trauma evaluation process. Designed as part of the Advanced Trauma Life Support (ATLS) protocols, this systematic approach is an important aspect of the initial assessment and management of trauma patients. The following are important parts of the primary trauma survey:

Airway assessment

Protecting the cervical spine from potential injury is vital, as is ensuring that the patient’s airway is clear. Airway obstruction can be a silent threat, an unnoticed blockage could deprive vital organs of oxygen. Quick action in airway management, such as repositioning the head, removing visible obstructions, and keeping the cervical spine immobilized, can be lifesaving.

Breathing and ventilation

Once the airway is confirmed to be clear, the focus shifts to the patient's breathing. Is it adequate? Are there signs of distress or chest injury? This stage might call for interventions like positive pressure ventilation, especially if the patient struggles to breathe efficiently.

Circulation with hemorrhage control

A trauma patient's blood pressure is a telling sign. Is there uncontrolled bleeding? Could shock be setting in? Assessing circulation is not just about checking the pulse or applying pressure to wounds. It is also about understanding the subtle signs of internal bleeding and quickly escalating care.

Disability

A rapid but thorough neurological examination assesses the level of consciousness and any potential brain injury. Even in the rush of initial evaluation, checking pupil response and extremity movement can give critical insights into the patient's neurologic status.

Exposure and environmental control

Finally, the patient needs to be fully exposed. This means that clothes are respectfully removed to allow for a complete examination. However, it’s essential to prevent hypothermia, so keeping the patient warm during this vulnerable time is crucial.

Who conducts these surveys?

A clock starts ticking when a trauma patient arrives at the emergency department. Immediate assessment and treatment can significantly influence the outcome. A trauma team is at the head of the crucial initial evaluation. The trauma team can be a multidisciplinary group, each member bringing unique skills and expertise necessary for trauma patients' trauma assessment and stabilization. These people form the trauma team and can conduct the Primary Trauma Survey.

Trauma team leader

Typically, an experienced trauma surgeon or an emergency medicine physician, the trauma team leader conducts the Primary Trauma Survey. They assess the patient's condition, prioritize treatment interventions, and coordinate the entire team's actions. Leadership, quick decision-making, and maintaining calm under pressure are the hallmarks of an effective team leader.

Emergency medicine physicians and surgeons

These physicians work closely to assess and address immediate life-threatening injuries. Surgeons, including specialists like neurosurgeons or orthopedic surgeons, may be called upon depending on the nature of the injuries.

Trauma nurses

Trauma nurses play a critical role in the trauma team, providing essential care and support throughout the Primary Trauma Survey. They're responsible for monitoring vital signs, administering medication, assisting with procedures, and providing compassion for the patient in a terrifying situation.

Respiratory therapists

Respiratory therapists are key team members since airway and breathing issues are a primary focus. They are experts in managing airways, providing oxygen therapy, and assisting with positive pressure ventilation when necessary.

Radiologists and radiology technicians

Rapid access to diagnostic imaging can be crucial for trauma patients. Radiologists and their technicians ensure that X-rays, CT scans, and other imaging studies are performed promptly and interpreted accurately, providing critical information that guides treatment decisions.

Other specialists

Depending on the injuries, other specialists, such as neurologists, cardiologists, and pediatricians (in cases involving children), might be part of the trauma team or consulted quickly as needed.

How does our Primary Trauma Survey template work?

The Primary Trauma Survey template guides responders and people in the trauma team to confidently navigate through the primary survey and management of a trauma patient. Let's walk through the specific steps to use this template effectively:

Step 1: Preparation

Before a patient arrives, familiarize yourself with the content of the template. 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 2: Initiate the survey

When the patient arrives, begin the survey with the 'A' step - Airway assessment with Cervical Spine protection. Consider any observed obstructions and the actions taken for removal and cervical spine precautions.

Step 3: Proceed systematically

Move systematically through the 'B', 'C', 'D', and 'E' steps – Breathing and Ventilation, Circulation with Hemorrhage control, Disability (neurological evaluation), and Exposure/Environmental control. For each step, check the relevant items, perform the listed actions, and document your observations and interventions in the notes section afterward.

Step 4: Communicate with the team

Communicate findings and actions throughout the survey to the rest of the trauma team. This collaborative approach ensures everyone is kept in the loop, promoting efficiency with each member's function and a shared understanding of the patient's condition.

Step 5: Complete the documentation

After completing the survey, ensure all findings and interventions have been fully and accurately documented in the template. This information will be essential for the patient's continued care and the care transfer between teams.

What do healthcare professionals do next after accomplishing the survey?

Completing the Primary Trauma Survey (PTS) 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 commonly taken:

• Secondary survey: After stabilizing immediate life-threatening conditions, the team conducts a thorough Secondary Trauma Survey. This more detailed examination covers the patient from head to toe, searching for any less apparent injuries the PTS might have missed.
• Diagnostic tests: Based on findings from both surveys, the team orders appropriate diagnostic tests - X-rays, CT scans, blood tests, etc. - to confirm suspicions or discover hidden injuries.
• Reevaluation: Trauma care is dynamic. A patient's status can change quickly. Continuous monitoring ensures the team can respond to these changes in real time.
• Specialized care: Patients with confirmed or suspected injuries requiring specialist intervention are fast-tracked. Whether it's surgery, admission to the Intensive Care Unit (ICU), or a consultation with a specialist, the aim is to provide targeted, expert care without delay.
• Formulating a treatment plan: Armed with complete information from the surveys and diagnostic tests, the team formulates a treatment plan tailored to the patient’s needs. This plan outlines the immediate next steps and longer-term care strategies, ensuring a pathway to recovery.

Why use Carepatron as your general practice software?

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