This Daily Doodle acts as a simple visual reminder of the steps involved in the primary survey of a trauma patient. Remember your ABCs (plus D and E). Quick overview:
A – Airway with Cervical Spine Control: Assume cervical spine injury if any injury above the clavicle, altered level of consciousness or multiple trauma. Stabilize the C-Spine with an appropriate sized collar or manual stabilization/support. Speak to the patient, if the patient responds, airway is patent, if patient does not respond, try to visualize airway for obvious obstruction. Suction vomit/mucus if present. Beware of snoring/gurgling (sign of obstruction). O2 mask. Secure airway (will be discussed in another doodle).
B – Breathing: Assess adequacy of ventilation, look for symmetric rise/fall of chest, midline trachea, peripheral signs (flared nostrils, accessory muscles), listen to both lungs. Count the respiratory rate.
C – Circulation and hemorrhage control: Control external hemorrhage with direct pressure. Measure blood pressure and heart rate. Rapid assessment of blood pressure by palpation: carotid pulse (systolic BP >60 mm Hg), femoral pulse (systolic BP >70 mm Hg) and radial pulse (systolic BP >80 mm Hg). Look for signs of shock (tachycardia, tachypnea, decreased capillary refill, cool extremities, decreased urine output, narrowed pulse pressure, decreased level of consciousness and hypotension).
D – Disability / Dysfunction of Central Nervous System: Brief neurologic exam including level of consciousness, pupil size and reactivity, speech, and motor function. Determine and record Glasgow Coma Scale.
E – Environment / Exposure: Cut away all clothing with scissors to fully expose patient for proper assessment. Keep patient warm when not being examined. Keep environment at warm temperature.
- P. Driscoll and D. Skinner. “ABC of major trauma. Initial assessment and management–I: Primary survey.” BMJ. May 1990.
- P. Rowe. “Trauma”. UBC Academic Half-Day Lecture Series. February, 2013.
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02/26/13 – “ABCs of Trauma” Daily Doodle by Michiko Maruyama