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Airway/C-spine. Breathing. Circulation. Disability. Exposure. Secondary Survey.

Airway and C-Spine

  • General airway principles
    • “If they can’t speak, they can’t control their airway”
    • “If GCS is <8, intubate”
      • In the real world, it’s a clinical judgement call
  • General c-spine principles
    • Clear c-spine with NEXUS/Canadian rules
    • Otherwise stabilize spine and place in cervical collar

Breathing

  • If patient has tachypnea, hypoxemia, or respiratory distress
    • Give O2
    • Examine for tension pneumothorax
      • Deviated trachea
      • Asymmetric breath sounds
        • If concerned perform needle decompression
        • THEN
        • Tube thoracostomy

Circulation

  • If patient has tachycardia, hypotension, or obvious blood loss
  • Stop the bleed
  • Emergent transfusion
  • Consider early OR if unstable
    • In the real world, CT is frequently obtained pre-op regardless of stability

Disability

  • Pupils
  • GCS
  • If concerned for head injury
    • Obtain CT head without contrast

Exposure

  • Fully undress the patient
  • Warm blankets

Secondary Survey

  • Visualize everything
  • Palpate everything
  • Bedside chest/pelvic x-ray and FAST scan

Common Labs

  • Type and screen
  • CBC
  • Electrolytes
  • Urinalysis
  • EKG
  • Blood alcohol level
  • Lactic acid (if concerned for shock)

Common Imaging

  • CT head without contrast
  • CT maxillofacial without contrast
  • CT cervical spine without contrast
  • CTA neck
  • CT abdomen/pelvis WITH contrast
  • Retrograde urethrogram
  • Additional x-rays

Common Treatments

  • Blood products
  • Tetanus immunization
  • Analgesics

Additional Reading