What interventions should a nurse perform during the primary survey of a trauma patient?

Interventions Performed by a Nurse During the Primary Survey of a Trauma Patient

During the primary survey of a trauma patient, the nurse should perform endotracheal intubation, needle decompression, and IV fluid administration as these are the critical interventions that address immediate life-threatening conditions. 1

ABCDE Approach to Primary Survey

A - Airway with Cervical Spine Protection

• Establish and maintain a patent airway while protecting the cervical spine 1
• Consider oro- or nasopharyngeal airways as temporary measures 1
• Perform endotracheal intubation for definitive airway protection in severe cases with altered consciousness (GCS <8) 2, 1

B - Breathing and Ventilation

• Ensure adequate oxygenation and ventilation 1
• Apply initial normoventilation if no signs of imminent cerebral herniation 2, 1
• Perform immediate needle decompression for suspected tension pneumothorax with hemodynamic instability 1, 3
  • Use either a 10-gauge or 14-gauge, 3.25-inch needle/catheter unit 3
  • Insert at either the lateral site (5th intercostal space at anterior axillary line) or anterior site (2nd intercostal space at midclavicular line) 3
  • Insert perpendicular to chest wall all the way to the hub 3
  • Hold in place for 5-10 seconds before removing the needle 3

C - Circulation with Hemorrhage Control

• Apply tourniquets to stop life-threatening bleeding from open extremity injuries 2, 1
• Initiate IV fluid resuscitation for hypotension 1
• Apply local compression to open wounds to limit life-threatening bleeding 2
• Remove wet clothing to facilitate examination and prevent hypothermia 2, 1

D - Disability (Neurological Status)

• Rapidly assess neurological status using Glasgow Coma Scale 1
• Control seizures if present 1

E - Exposure/Environmental Control

• Completely undress the patient to facilitate thorough examination 1
• Implement warming measures to prevent hypothermia 1

Point-of-Care Diagnostics During Primary Survey

• Perform point-of-care ultrasonography (POCUS), including FAST (Focused Assessment with Sonography for Trauma), for patients with thoracoabdominal injuries 2, 4
• Measure blood glucose to identify hypoglycemia, a common stroke mimic 2

Common Pitfalls to Avoid

• Delaying definitive intervention in unstable patients can lead to poor outcomes 1
• Relying solely on blood pressure as an indicator of hemodynamic stability can be misleading 1
• Failing to recognize transient responders who initially stabilize with fluid resuscitation but later decompensate 1
• Performing needle decompression with insufficient needle length - studies show standard 4.5cm needles may fail to reach the pleural space in up to 35.4% of female patients 5, 6
• Neglecting to perform tube thoracostomy after needle decompression - studies show 83-85% of patients require tube thoracostomy following needle decompression 7
• Premature intubation in hemorrhagic shock may reduce cardiac output and worsen shock - consider delayed intubation in patients maintaining adequate oxygen saturation 8

Key Time Targets for Primary Survey

• Door-to-doctor first sees patient: 10 minutes 2
• Door-to-CT completed: 25 minutes 2
• Door-to-CT read: 45 minutes 2
• Door-to-thrombolytic therapy starts (if applicable): 60 minutes 2

Remember that the primary survey focuses exclusively on immediately life-threatening conditions using the ABCDE approach, with interventions performed simultaneously rather than sequentially when multiple providers are available 4, 1.