Emergency Medicine – Trauma: What You Need to Know Whiteboard Animation Transcript with Kaushal Shah, MD

Trauma comes in two basic varieties: blunt trauma and penetrating trauma. Nonetheless, major trauma patients should always be approached the same way: primary survey followed by a secondary survey. Don’t let the blood and gore distract you. The primary survey entails a systematic assessment using ABCDE in order to identify the true life-threatening injuries and initiate resuscitation. Then a detailed head-to-toe exam should occur, which we call the secondary survey.

A. Airway assessment. If blood, vomit or the patient’s own saliva is blocking the airway (which often occurs in unconscious patients), they will need suctioning and possibly intubation.

B. Breathing. Examine the chest through inspection, auscultation, and palpation. You are looking for life-threatening injuries.

Decreased breath sounds, subcutaneous emphysema, broken ribs, and tracheal deviation, are concerning for a tension pneumothorax, hemothorax, pulmonary contusions, flail chest, and cardiac tamponade.

C. Circulation. If the patient has a fast heart rate or low blood pressure, suspect ongoing hemorrhage or blood loss, the number one cause of preventable death in trauma. Bleeding is likely in one of four locations: chest, abdomen, pelvis, or fractured long bones. Start IV fluids or blood transfusion through two big intravenous lines.

D. Disability. A basic neurologic assessment will help you calculate a GCS or Glasgow Coma Scale. It evaluates Eye Opening, Verbal Response, and Motor Response that is universally understood on a 15-point scale.

E. Exposure. The patient should be completely undressed to look for all injuries.

Along with the secondary survey, the major trauma patient often requires a chest x-ray, pelvis x- ray, and an ultrasound of the abdomen called a FAST (focused assessment with sonography in trauma). This will allow identiﬁcation of blood loss from the most common sources.

If blood loss exceeds the resuscitation with fluid and blood, the patient will spiral into the classic trauma triad of death: acidosis, coagulopathy, and hypothermia.