With regard to emergency trauma care, a few minutes can mean the difference between life and death. The first hour of definitive medical care is “golden hour” (the hour in which if we resuscitate the patient we may prevent death). The primary survey is designed to assess and treat any life-threatening injuries quickly.
The main causes of death in a trauma patient are airway obstruction, respiratory failure, shock from haemorrhage, and brain injuries. Therefore, these are the areas targeted during the primary survey.
Following are specific injuries identified during a primary survey, which may be potentially life-threatening:
- Airway obstruction
- Tension pneumothorax
- Massive internal or external haemorrhage
- Open pneumothorax
- Flail chest
- Cardiac tamponade
Below is each sequential area of focus for evaluation and intervention
A: Airway with cervical spine precautions /or protection
This assessment is of the patency of the patient’s airway. The cervical spine should be stabilized by manually maintaining the neck in a neutral position, in alignment with the body. Airway protection is required in many trauma patients and is best executed by an expert.
B: Breathing and Ventilation
This assessment is performed first by inspection. The practitioner should look for tracheal deviation, an open pneumothorax or chest wounds, flail chest, or paradoxical chest movement, or asymmetric chest wall excursion. Then, auscultation of both lungs should be conducted, to identify decreased or asymmetric lung sounds. Note that in general, all trauma patients need supplemental oxygen.
C: Circulation with haemorrhage control
This is evaluated by assessing the level of responsiveness, obvious haemorrhage, skin colour, and pulse (presence, quality, and rate).
D: Disability (assessing neurologic status)
This is assessed by the patient’s GCS, pupil size and reaction, and lateralizing signs.
E: Exposure and Environmental Control
The patient should be completely undressed and exposed, to ensure that no injuries are missed. They should then be re-covered with warm blankets to limit the risk of hypothermia.
In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. Trauma can be handled only by trained experts and emergency department is equipped to handle the same.