From the Guidelines
The primary survey for a patient involved in a motor vehicle accident (MVA) with a head-on collision should follow the ABCDE approach, as outlined in the Advanced Trauma Life Support (ATLS) guidelines, which is a well-structured standard for directing patient assessment and potentially life-saving interventions 1.
Primary Survey Components
The ABCDE approach includes:
- Airway assessment, ensuring patency while maintaining cervical spine immobilization with a hard collar due to the high risk of cervical injury in head-on collisions
- Breathing evaluation, assessing respiratory rate, effort, oxygen saturation, and auscultating the chest for equal air entry, looking for signs of pneumothorax or hemothorax
- Circulation check, including pulse rate and quality, blood pressure, capillary refill time, and identifying any external hemorrhage requiring immediate control
- Disability assessment, checking the Glasgow Coma Scale, pupillary responses, and limb movements to identify neurological deficits
- Exposure of the patient to examine for additional injuries while preventing hypothermia with warm blankets
Key Considerations
Throughout the primary survey, it is essential to:
- Administer supplemental oxygen as needed
- Consider early blood product administration if signs of hemorrhagic shock are present
- Prepare for potential emergency interventions such as intubation, chest decompression, or pelvic binding based on findings
- Establish IV access with two large-bore cannulas (16-18G) and collect blood samples for crossmatch, complete blood count, and biochemistry
Evidence-Based Practice
The ATLS guidelines, as mentioned in the study 1, provide a standardized approach to the primary survey, which is crucial in identifying and managing life-threatening injuries in the critical first minutes after arrival. Although the study notes that healthcare professionals do not always adhere to ATLS guidelines, the ABCDE approach remains the recommended standard for the primary survey in trauma patients, including those involved in MVAs with head-on collisions.
From the Research
Primary Survey for MVA Patients
The primary survey for a patient involved in a motor vehicle accident (MVA) with a head-on collision involves assessing the patient's:
- Airway: establishment and maintenance of a patent airway while maintaining cervical spine immobilization 2
- Breathing: evaluation of breathing, ventilation, and oxygenation, with immediate treatment of tension pneumothorax, open pneumothorax, and massive hemothorax 2
- Circulation: evaluation and treatment of circulatory compromise and shock 2
- Disability: assessment of neurologic status, signs of increased intracranial pressure, and impending cerebral herniation 2
- Exposure: exposure while preventing hypothermia 2
Assessment Approach
The primary survey approach is a priority-based consensus approach for the primary assessment of all categories of critically ill or injured patients, including those involved in MVAs 3, 4. This approach is also known as the ABCDE approach, which is a systematic and sequenced approach to patient assessment 3, 4.
Application in Trauma Care
The ABCDE primary survey is a crucial first step in trauma resuscitations, and its process modeling can support agent-based simulation modeling of complex team-based clinical processes 5. The primary survey identifies acute life-threatening problems that must be managed immediately, while the secondary and tertiary surveys identify remaining major injuries and occult injuries, respectively 6.