This document discusses primary trauma care and outlines the steps for assessing and managing trauma patients. It covers triaging patients, performing a primary and secondary survey, identifying life-threatening injuries, providing initial resuscitation and stabilization, and determining appropriate disposition. The primary goals are to assess and treat airway, breathing, circulation and disability issues; control hemorrhage; and identify injuries requiring surgical intervention. Proper trauma management in the first hours can significantly impact outcomes.

2. Primary Trauma Care
Dr Imran Javed.
Associate Prof Surgery.
Fiji National University.

5. Introduction
• There are notable disparities in the outcome of trauma
care around the world.
• 60% of preventable trauma associated deaths occur in
the first 24 hours.
• Difficulties facing trauma care in developing countries
include manpower development, infrastructure,
availability of equipment and organization.
• Much of the improvement in trauma care has resulted
from better organization of trauma care services.
• The main focus of this module is appropriate life-saving
management in the first few hours following trauma.

11. Learning Outcomes
• Discuss the burden of trauma
• Describe the concept of triage
• Identify common life-threatening injuries
• Adequately resuscitate and re-evaluate the trauma patient
• Manage common life-threatening injuries effectively
• Perform a secondary survey to plan the next stage of care

14. Triage in the emergency room
• The first is quiet and appears calm and still
• The second is in excruciating pain from an obvious
femoral fracture with the foot twisted in the opposite
direction
• The third patient is screaming at the site of his clothes
soaked with blood from an extensive scalp laceration
• The fourth patient walks-in complaining of right sided
chest pain and difficulty with breathing

16. Managing the severely injured patient
Initial management (resuscitation)

18. Catastrophic hemorrhage:
the exception to “A,B,C,D,E”
• This is life threatening hemorrhage, often due to
traumatic amputation or crush injury to the
limbs. Bleeding is usually massive and the patient
may be on the point of exsanguination.
• It is necessary to rapidly control the hemorrhage
before assessing the airway.
• The bleeding vessel may be ligated if it can be
identified. If not, this may be one of the
exceptional cases when a tourniquet may be
used. However, the duration of application must
be noted.

19. Airway management: The conscious patient
• Speak to the patient.
• Does he respond? If he responds in a normal voice giving a
logical answer then he most probably can control his airway.
• However, cervical spine injury (CSI) may be present. First,
inspect the neck meticulously for wounds and other
abnormalities.
• Cover any penetrating wounds with clean gauze and plaster.
• Then, immobilize the cervical spine using one of these
methods:
• MILS (Manual in-line stabilization)
• Cervical collar
Spinal board, head blocks, sandbags

20. Primary Survey - Airway
• Maintain C-spine precautions
• Clear any obstructions
• Jaw thrust instead of head tilt chin lift
• Endotracheal intubation for airway protection
or expected clinical course (ie obstruction
from blood or vomitus, neck hematoma, facial
burns or trauma, GCS 8 or less, combative
patient, potential for airway compromise
while out of department.)

21. Primary Survey - Breathing
• Auscultation for bilateral breath sounds
• Palpation for subcutaneous emphysema
-needle decompression followed by chest tube for
pneumothorax
• Inspection for flail chest
• Observation of respiratory rate, oxygen
saturation, and overall work of breathing
-mechanical ventilation for inadequate ventilation
or to decrease work of breathing

23. Primary Survey - Circulation
• Check peripheral pulses, heart rate, BP,
pulse pressure, capillary refill, cyanosis
• All hypotensive trauma patients are
assumed to be in hemorrhagic shock
• 2 large bore peripheral IV’s (at least 18
gauge)
• Control external bleeding

26. Primary Survey - Circulation

27. Primary Survey - Circulation
• Begin volume resuscitation with liter boluses of
crystalloid for class I or II hemorrhage.
• Begin crystalloid and blood for class III or IV
hemorrhage.
• O- blood until type specific is available
• Constant reevaluation is paramount
• If class I or II is patient still showing signs of shock
after 3L of crystalloid, begin blood
• “3:1 rule” 3cc crystalloid for every 1cc of blood
loss

28. Primary Survey - Circulation
• 5 Places life threatening hemorrhage can
occur
• -Chest
• -Abdomen
• -Pelvis
• -Thighs
• -Externally

29. Primary Survey - Circulation
• Cardiac Tamponade can cause hypotension
with little blood loss.
• Becks triad: hypotension, distended neck
veins, muffled heart sounds
• Easily confirmed with ultrasound
• Pericardiocentesis
• Pericardial Window.

32. Primary Survey - Disability
• Quick assessment of ability to move all
extremities
• Glasgow Coma Scale.

34. Primary Survey – Exposure
• Completely undress the patient and
inspect the entire patient from head to
toe both front and back.
• Maintain spinal precautions during
logrolling
• Inspect both axillae and Perineum.
• Warm blankets!!!

35. Secondary Survey
• Head to toe evaluation once any derangements in
primary survey have been addressed.
• AMPLE History
• -Allergies
• -Medications
• -Past medical history (LMP, Td, transfusions)
• -Last meal
• -Events leading up to trauma

36. Imaging – Plain Films
• Choice of imaging modality depends on
nature of injuries and stability of patient.
• Knowledge of injury mechanism and index of
suspicion most important
• Can be performed at bedside
• Useful for rapid identification of
pneumothorax, hemothorax, fractures and
locating ballistics

38. Imaging – Ultrasound
• Quick
• Can be performed at bedside
• FAST: Focused Assessment with
Sonography for Trauma
• Rapid examination to identify free
intraperitoneal fluid and/or pericardial
fluid

40. Imaging – CT
• Detailed
• Requires patient to leave the department
• Necessary for head trauma

41. Disposition
• To the OR
• -Unstable patients with blunt or penetrating
abdominal trauma or chest trauma. Hemothorax
with >1500 cc of blood out initially. Surgical
injuries identified with imaging.
• Admission
• -Nonsurgical, high-risk injuries
• Discharge
• -Stable patients, minor or no injuries
identified.