The document discusses the primary and secondary survey process for patients with polytrauma or severe trauma. The primary survey focuses on assessing life-threatening conditions following the ABCDE approach of evaluating the airway, breathing, circulation, disability and exposure. This helps identify issues like airway obstruction, respiratory distress, hemorrhage or neurological impairment. Once the primary survey is complete and stabilization underway, the secondary survey involves a full physical exam from head to toe to check for any injuries that were not life-threatening but still require treatment.

1. PRIMARY AND SECONDARY
SURVEY IN POLYTRAUMA AND
TRAUMA CASE
PRESENTED BY:-
DR GAYADEEN

2. PRIMARY SURVEY
• Patients are assessed and their treatment priorities are estabilised
based on their injuries,vital signs and injury mechanism.
• The primary survey encompasses the ABCDEs of trauma care and
identifies life threatning conditions by adhering to this sequence:
• A Airway maintenance with restriction of cervical spine motion
• B Breathing and ventilation
• C Circulation with hemorrhage control
• D Disability (assessment of neurological status)
• E Exposure/environmental control

3. AIRWAY MAINTENANCE WITH RESTRICTION OF
CERVICAL SPINE MOTION
• This rapid assessment for signs of airway obstruction includes inspecting
for foreign bodies;
• identifying facial,mandibular,and or tracheal/laryngeal fractures and other
injuries that can result in airway obstruction ;
and suctioning to clear accumulated blood or secretions that may lead to
be causing airway obstruction.
• Patients with severe head injuries who have a alter level of consciousness
or GCS score of 8 or lower usually required the placement of definite
airway
• If patient able to communicate verbally the airways not likely to be
immediate jeopardy.

4. • While assessing and managing the patients airway take care to
prevent excessive movement of cervical spine
• Neurological examination alone does not exclude a diagnosis of
cervical spine injury.
• Cervical spine is managed with cervical collar and when management
is necessary cervical collar is opened and a team member manually
restrict motion of cervical spine

6. BREATHING AND VENTILATION
• Airway patency alone does not ensure adequate ventilation
• Ventilation require adequate function of lung, chest wall and
diaphragm
• Injuries that significantly impair ventilation in the short term included
tension pneumothorax, massive haemothorax ,open pneumothorax
and tracheal or bronchial injury .
• Every injured should receive supplementary oxygen
• A simple pneumothorax can convert into tension pneumothorax
when patient is intubated and positive pressure ventilation is provide
before decompressing the pneumothorax with chest tube.

7. CIRCULATION WITH HEMORRHAGE CONTROL
• Blood volume ,cardiac output ,bleeding are major circulatory issues to
consider.
• BLOOD VOLUME AND CARDIAC OUTPUT
• Haemorrhage is predominant cause of preventable death after injury
• Identify, quickly controlling haemorrhage and initial resuscitation are
therefore crucial step in assessing and managing such patients.
• The elements of clinical observation that yield important information
within seconds are level of consciousness, skin perfusion and pulse

8. TYPE OF SHOCK
• • Hypovolumic shock
• • Cardiogenic shock
• • Obstructive shock
• • Distributive shock
• • Endocrine shock

10. • LEVEL OF CONSCIOUSNESS:- When circulating blood volume is reduced
,cerebral perfusion may be critically impaired,resulting in an altered level of
consciousness
• SKIN PERFUSION:- This sign can be helpful in evaluating injured
hypovolemic patients.A patient with pink skin,especially in the face and
extremities,rarely has critical hypovolemia after injury,Conversely a patient
with hypovolemia may have ashen,gray facial skin and pale extremities.
• PULSE:-A rapid thread pulse is typically sign of hypovolemia .Assess a
central pulse bilaterally for quality ,rate and regularity.Absent central
pulses that cannot be attributed to local factors signify the need for
immediate resuscitative action.

11. BLEEDING
• Identify the source of bleeding as external or internal
• External direct haemorrhage is identified and controlled during the primary survey.
• Rapid, external blood loss is managed by direct pressure on wound.
• The major areas of internal haemorrhage are the chest,abdomen,retro peritoneal,pelvis
and long bones.
• The source of bleeding is usually identified by physical examination and imaging.ex-
Chest Xray, FAST and DPL.
• Definitive bleeding control is essential along with appropriate replacement of
intravascular volume
• Aggressive and continued volume resuscitation is not a substitute for definitive control of
haemorrhage
• All IV solution should be warmed either by storage in warm environment(37-40 degree
Celsius) are administered through fluid warming device

12. DISABILTY (NEUROLIGICAL EVALUATION)
• A rapid neurological evaluation stabilizes the patient level of
consciousness and pupil size and reaction
• GCS is quick and simple and objective method of determining the
level of consciousness.
• The motor score of GCS correlate with outcome.
• A decrease in level of consciousness may indicate decrease cerebral
oxygenation and perfusion or direct cerebral head injury

13. EXPOSURE AND ENVIRONMENTAL CONTROL
• During primary survey completely undress the patient usually by
cutting his/her clothes to facilitate thorough examination and
assessment,
• After completing the assessment with warm blanket or an external
warming device to prevent his/her from developing hypothermia.

14. SECONDARY SURVEY
• The secondary survey does not begin until primary survey is
completed,resuscitative effort are underway and improvemt patient
vitals functions have been demonstrated
• The secondary survey is head to toe examination of trauma patient ie
complete history and physical examination including reassement of all
vital signs.
• Each region of body is completely examined.

15. HISTORY
• Every complete medical assessment includes a history of mechanism
of injury.
• Includes :- allergies,
• medication currently used,
• past illness or pregnancy
• last meal ,
• events/environment related to the injury

16. • Knowledge of the mechanism of injury can enhance understanding of
the patients physiological straight and provide clue of anticipated
injuries.

17. BLUNT TRAUMA
• Blunt trauma often results from automobile collisons falls and other
injuries related to transportation and occupation
• Important information to obtain about automobile collisons includes
• Seat belt use
• Steering wheel deformation
• Present and activation of airway device

18. PENETRATING TRAUMA
• Factors that determine type and extent of injury and subsequent
management includes the body organ that was injured organs in the
path of the penetrating object, and velocity of the missile. Therefore
in gunshot victims the velocity,caliber,presumed path of the bullet
and distance from weapon to the wound can provide important clues
regarding the extent of injury.

19. PHYSICAL EXAMINATION
• During the secondary survey physical examination follows sequence of head,
maxilla facial structures, cervical spine and neck, chest
,abdomen,pelvis,peritoneum/rectum/vagina,musculoskeletal and then
neurological system
• HEAD
• The secondary survey begins with evaluating the head to identify all related
neurological injury and any other significant injury
• MAXILLOFACIAL STRUCTURES
• Examination of face should include palpation of all bony structure,assessment of
occlusion ,intra oral examination and assessment of soft tissue.
• Maxillofacial trauma that is not associated with airway obstruction and major
bleeding should be treated only after the patient is stabilized and life threatning
injuries has been managed.

20. • CERVICAL SPINE AND NECK
• Patient with maxillofacial or head trauma should be presumed to
have a cervical spine injury and cervical spine motion must be
restricted
• CHEST
• Visual evaluation of chest both anterior and posterior can identify
conditions such as open pneumothorax and large flair segments.
• Significant chest injuries can manifest with pain,dyspnoea and
hypoxia.

21. • ABDOMEN AND PELVIS
• Abdominal injury must be identified and treated aggressively
• Pelvis fracture can be suspected by identification of ecchymosis over iliac
wings,pubis,labia or scrotum
• PERINEUM,RECTUM AND VAGINA
• Perineum should examine for contusion,hematoma,laceration and urethral
bleeding
• MUSCULOSKELETAL
• The extremities should be inspected for contusion and deformity
• Palapation of bones and examination for tenderness and abnormal
movement adds in the identification of occult fractures

22. • NEUROLOGICAL SYSTEM
• A comprehensive neurological examination includes motor, sensory
evaluation of extremities as well as revaluation of the patients level of
consciousness and pupil size and response
• The GCS score facilitates detection of early changes and trends in
patient neurological status