From the Guidelines
The primary assessment of trauma follows a systematic ABCDE approach to quickly identify and address life-threatening conditions. Begin with Airway assessment, ensuring it's patent and protecting the cervical spine if needed. Next, evaluate Breathing by checking respiratory rate, effort, and oxygen saturation. Circulation assessment follows, examining pulse quality, blood pressure, and controlling any major hemorrhage. Then assess Disability by checking the patient's neurological status using the Glasgow Coma Scale and pupillary response. Finally, Exposure involves completely undressing the patient to identify all injuries while preventing hypothermia. Throughout this process, perform life-saving interventions immediately as problems are identified rather than completing the entire assessment first. This structured approach prioritizes the most critical physiological functions first, as airway obstruction or severe bleeding will cause death more rapidly than other injuries. The primary assessment should take only minutes to complete, with the goal of identifying and addressing immediate life threats before moving on to a more detailed secondary assessment, as supported by the most recent guidelines 1.
Some key points to consider during the primary assessment include:
- The use of the shock index and/or pulse pressure to assess the degree of hypovolaemic shock and transfusion requirements 1
- The importance of minimizing elapsed time between injury and operation 1
- The role of tourniquet use in stopping life-threatening bleeding from open extremity injuries 1
- The need for initial normoventilation of trauma patients if there are no signs of imminent cerebral herniation 1
It is essential to note that the primary assessment is not a one-size-fits-all approach and should be tailored to the individual patient's needs and circumstances. However, the ABCDE approach provides a standardized framework for evaluating and managing trauma patients, and its use is widely supported by the medical literature 1.
In terms of specific recommendations, the most recent and highest quality study 1 suggests that the physician clinically assess the extent of traumatic haemorrhage using a combination of patient physiology, anatomical injury pattern, mechanism of injury, and the patient's response to initial resuscitation. This approach is supported by other studies, which emphasize the importance of a thorough and systematic assessment of the trauma patient 1.
Overall, the primary assessment of trauma is a critical component of trauma care, and its effective implementation can help to reduce morbidity, mortality, and improve quality of life for trauma patients.
From the Research
Primary Assessment of Trauma
The primary assessment of trauma involves several critical steps to ensure the patient's airway, breathing, and circulation are stable. The following are the key steps in a primary assessment of trauma:
- Establishment or maintenance of a patent airway 2
- Ensurance of adequate breathing 2
- Resuscitation of the circulation 2
- Cursory survey to identify immediately life-threatening injuries and to prevent permanent disability 2
- Securing the airway, which is the first step in the introduction of general anesthesia 3
Airway Management
Airway management is a critical component of trauma care. Establishing a secure airway in a trauma patient is one of the primary essentials of treatment 3. Any flaw in airway management may lead to grave morbidity and mortality. In patients with maxillofacial trauma, airway management can be complex due to the potential for difficult endotracheal intubation and mask ventilation 3.
Circulation and Resuscitation
Resuscitation of the circulation is also critical in trauma care. This may involve the use of tranexamic acid (TXA) to prevent or treat hemorrhagic shock 4, 5, 6. TXA has been shown to be effective in reducing mortality in trauma patients with hemorrhagic shock, particularly when administered early after injury 5, 6.
Additional Considerations
In addition to airway management and circulation, the primary assessment of trauma should also include a cursory survey to identify any immediately life-threatening injuries and to prevent permanent disability 2. This survey should include an evaluation of the patient's vital signs, including heart rate, blood pressure, and respiratory rate, as well as an assessment of the patient's level of consciousness and any obvious injuries.