4. •Airway maintenance + restriction
of cervical spine motion
•Breathing & ventilation
•Circulation + hemorrhage control
•Disability (neurologic status)
•Exposure/Environment control
Primary Survey
5. •Clinicians can quickly assess A,
B, C, and D by identifying
themselves, asking patient for
his/her name, and asking what
happened.
10-second
assessment
20. Open Pneumothorax
• Large injuries to chest wall
sucking chest wound
• Signs : tachypnea, decreased
breath sounds on affected side,
noisy movement of air through
chest wall injury
21. Open Pneumothorax
• Immediate management
o Occlusive dressing, taped on
three sides to create a flutter-
valve effect
22. Massive Hemothorax
• Rapid accumulation >1500 mL of
blood or 1/3 of blood volumein
chest cavity
• Signs : hypotension,
tachycardia, absence of breath
sounds, dullness on percussion
over affected lung
23. Massive Hemothorax
• Immediate management
o Chest tube : 28-32 Fr, 5th ICS,
just anterior to midaxillary line
o Immediate return of >1500 mL
of blood OR continuing blood
loss (200 mL/Hr for 2-4 hours)
Urgent thoracotomy
24. Flail Chest
• A segment of the chest wall does
not have bony continuity with
the rest of thoracic cage i.e.
Multiple adjacent rib fractures
• Signs : decreased respiratory
effort, hypoxia, paradoxical
chest wall movement, crepitus
25. Flail Chest
• Immediate management
o O2 administration
o Analgesia to improve
ventilation
o Judicious fluid administration
o Significant hypoxia
intubation
28. Signs of Shock
•Altered level of consciousness
•Impaired skin perfusion : pale skin
& extremities
•Tachycardia (HR >100)
29. Management of
Shock
1. Recognize presence of shock.
2. Identify probable cause of
shock & adjust treatment
accordingly.
*haemorrhage is the most
common cause of shock in
trauma patients
30. Recognition of Shock
•Pulse rate, pulse character,
respiratory rate, skin perfusion,
pulse pressure
•Cool to touch, tachycardic
shock until proven otherwise
•Massive blood loss may produce
only a slight decrease in initial
hematocrit/Hb
33. Management of
Haemorrhagic Shock
1. Obtain vascular access
• Two large bore (18G) IV
catheters
• Most desirable sites :
forearms, antecubital veins
2. Initial fluid therapy
• 1L (adult) & 20mL/kg for paeds
patients <40 kg of warmed
fluid bolus of isotonic fluid
36. • GCS
• Pupil size & reaction to light
• Monitoring signs of intracranial
hypertension
o Decreased pupillary response
to light
o Hypertension with bradycardia
o Posturing
o Respiratory abnormalities
Assessment of
Neurologic Status
37. • Mechanism : presence of
external force
• Physiological : alteration in
physiology of the brain
• Anatomical : scalp and/or face
and/or skull and/or brain injury
(internal & external)
Definition of Head
Trauma
38. • Mild : GCS 13-15
• Moderate : GCS 9-12
• Severe : 3-8
Severity of Head
Trauma
