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, prioritizing Airway, Breathing, Circulation, Disability, and Exposure/Environment assessments. This approach is crucial in identifying life-threatening injuries and providing timely interventions to prevent morbidity and mortality 1.
Key Components of the Primary Survey
- Airway assessment: ensuring patency while maintaining cervical spine immobilization with a hard collar and manual in-line stabilization due to the high risk of cervical injury in head-on collisions 1.
- Breathing assessment: exposing the chest to observe respiratory rate, pattern, and effort, and administering high-flow oxygen if necessary 1.
- Circulation assessment: evaluating pulse rate and quality, blood pressure, and capillary refill time, and controlling any external hemorrhage with direct pressure 1.
- Disability assessment: performing a rapid neurological assessment using the AVPU scale and checking pupillary response and Glasgow Coma Scale 1.
- Exposure/Environment assessment: completely undressing the patient to examine for additional injuries while preventing hypothermia with warm blankets and fluid warmers 1.
Importance of Continuous Reassessment
Throughout the primary survey, it is essential to continuously reassess the patient's condition, as their status may rapidly change due to the high-energy mechanism of injury 1. This ongoing evaluation will help identify any deterioration or improvement in the patient's condition, allowing for prompt adjustments to their care.
Considerations for Trauma Center Transport
According to the guidelines for field triage of injured patients 1, patients with severe injuries, such as those with a Glasgow Coma Scale score ≤13, systolic blood pressure <90 mmHg, or respiratory rate <10 or >29 breaths per minute, should be transported to a trauma center. Additionally, patients with penetrating injuries, chest wall instability, or other severe injuries should also be transported to a trauma center 1.
From the Research
Primary Survey for Motor Vehicle Accident (MVA) with Head-on Collision
The primary survey for a patient involved in a motor vehicle accident (MVA) with a head-on collision involves the systematic Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach. This approach is a priority-based consensus approach for the primary assessment of all categories of critically ill or injured patients 2, 3.
Key Components of the Primary Survey
The primary survey focuses on the ABCDE approach, which includes:
- Airway: assessing the patient's airway for any obstruction or damage
- Breathing: evaluating the patient's breathing pattern and respiratory rate
- Circulation: assessing the patient's circulatory status, including blood pressure and pulse
- Disability: evaluating the patient's neurological status, including level of consciousness and neurological deficits
- Exposure: exposing the patient to assess for any other injuries or conditions 3, 4
Importance of the ABCDE Approach
The ABCDE approach is widely accepted by experts and is likely to improve outcomes by helping healthcare professionals focus on the most life-threatening clinical problems 3. Adherence to the ABCDE approach can vary widely among healthcare professionals, and factors such as department, profession category, and age can influence knowledge and adherence to the approach 5, 4.
Application of the ABCDE Approach in Clinical Practice
The ABCDE approach is applicable in all clinical emergencies, whether the patient is located in the street, at home, in the emergency room, or in the intensive care or general wards of the hospital 3. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance 3.