Intensive Care Nursing/Trauma/Systematic Trauma Assessment

Pre-Hospital Management

Structured management of trauma patients and the use of trauma services is required for avoidable mortality and morbidity. All inclusive systems of trauma related services from the prehospital setting to the acute care facility are of the up most importance. The use of a major trauma triage tool will standardise and prioritise care to the appropriate level of trauma care.

Primary Survey

The primary survey should be carried out immediately on arrival and reassessed frequently throughout the initial and ongoing phases of care. In a trauma situation, the primary survey is focused on identifying and intervening on any potential or actual life-threatening injuries. The approach taken is:

• Airway (maintaining spinal alignment)
• Breathing
• Circulation (including haemorrhage control)
• Disability
• Exposure (including temperature control)

The time critical concept of carefully looking for signs of critical injuries.

Ideally there is a coordinated team approach with roles defined. Often each component assessments and interventions being completed concurrently. The general rule is, do not move on to the next step until you find and fixing/fixed the problem. For example, if a patient has a threat to the airway because of altered conscious state but also a partial amputation of the leg bleeding profusely, gaining control of the airway (through simple or advanced means) must be achieved while measures are taken to stop the bleeding.

Secondary Survey

Once the primary survey and all interventions are completed then the secondary survey can be performed. The secondary survey is a complete head to toe physical examination.

Tertiary Survey

This survey is to identify any missed injuries. After the initial resuscitation and any operative interventions and typically occurs within twenty four hours after admission and is repeated again when the patient is awake, responsive, and able to communicate. The tertiary trauma survey is a comprehensive review, includes the repetition of the primary and secondary surveys and review of all laboratory data. A secondary review of all scans may also be undertaken at this stage.

References[edit]

Curtis, K. & Ramsden, C., (2011) Emergency and Trauma Care for nurses and paramedics. Sydney:Mosby

Anaesthesia, Trauma and Critical Care (ATACC) Manual

ICUnurses (discuss • contribs)