From the Guidelines
The primary trauma assessment follows the ABCDE approach: Airway, Breathing, Circulation, Disability, and Exposure. This systematic approach is crucial in ensuring that no life-threatening conditions are missed during the critical first minutes of trauma care, when rapid identification and treatment of immediately life-threatening conditions significantly improves patient outcomes 1.
Key Components of Primary Trauma Assessment
- Airway: Ensure the airway is patent, removing any obstructions and considering intubation if necessary.
- Breathing: Assess breathing by observing chest rise, respiratory rate, and oxygen saturation, providing supplemental oxygen if needed.
- Circulation: Check pulse quality, blood pressure, and control any obvious hemorrhage, applying direct pressure to bleeding sites and considering tourniquets for severe extremity hemorrhage.
- Disability: Assess neurological status using the Glasgow Coma Scale, checking pupillary response and motor function.
- Exposure: Completely expose the patient by removing all clothing to identify hidden injuries, while maintaining body temperature. The use of the shock index (SI) and/or pulse pressure (PP) can also be beneficial in assessing the degree of hypovolaemic shock and transfusion requirements, as recommended by recent guidelines 1.
Additional Considerations
- Establish IV access with two large-bore (16-18 gauge) catheters and initiate fluid resuscitation with 1-2 liters of warmed crystalloid solution like normal saline or Lactated Ringer's.
- Consider the patient's physiology, anatomical injury pattern, mechanism of injury, and response to initial resuscitation to clinically assess the extent of traumatic haemorrhage 1. While older studies and guidelines, such as those from 2007 1, may provide valuable insights into trauma care, the most recent and highest-quality evidence should be prioritized in clinical decision-making.
From the Research
Primary Trauma Assessment
The primary trauma assessment is a critical step in the management of trauma patients. The assessment is guided by the Advanced Trauma Life Support (ATLS) principles, which emphasize a systematic and prioritized approach to initial management 2.
Key Components of Primary Trauma Assessment
The primary survey includes:
- Airway assessment and management, which is the first priority in trauma care 3
- Breathing and ventilation
- Circulation and resuscitation
- Disability and exposure, which are also crucial components of the primary survey 4
Systematic Approach
A systematic approach to primary trauma assessment is essential to ensure that optimal care is delivered and the best possible outcome is achieved. This approach involves a cursory survey to identify immediately life-threatening injuries and prevent permanent disability 5. The ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach is a widely accepted framework for primary trauma assessment, and its application has been studied in various settings 4.
Importance of Airway Management
Airway management is a critical component of primary trauma assessment, and airway compromise can occur due to traumatic injuries or altered mentation 3. The airway can be compromised by traumatic injuries or altered mentation, and airway assessment is conducted during the primary survey. Initial interventions include positioning maneuvers and suction to clear the airway with supplemental oxygen 3.
Prioritization of Assessment and Intervention
The primary trauma assessment should be continually repeated to identify deterioration in the patient's condition and to make appropriate interventions 2. The assessment should prioritize the establishment and maintenance of an effective airway, ventilation, oxygenation, and circulation 6.