Primary survey

• Airway with cervical spine immobilisation
• Breathing
• Circulation (with haemorrhage control)
• Disability
• Exposure

Assessment of airway

• How are you?
Information re airway patency, LOC
• Looking
Signs of hypoxia
Obvious trauma involving airway
• Listening
Abnormal sounds: eg stridor

Airway Procedures(1)

• Cervical spine immobilised with:
Hard collar or manual inline immobilisation
• Supplemental O2 (High flow)
• Establishing patent airway with:
Jaw thrust/chin lift
Oral airway
Suctioning

Airway Procedures(2)

• Endotracheal intubation - indications:
Need to protect airway and ensure patency
Correction of hypoxaemia
Severe head injury
Confusion/fluctuating LOC requiring Head CT
Major traumatic injury ­GA required on humane grounds +/- major surgery imminent

Airway Procedures(3) - Intubation technique

• Direct laryngoscopy most common approach
• Rapid sequence induction/ cricoid pressure
• Cervical spine immobilisation
• In practice in A&E: Thiopentone (dose depends on clinical status), Suxamethonium, then longer acting relaxant, sedation
• In Theatre: principles the same

Airway Procedures(4)

• Elective tracheostomy eg severe faciomaxillary injuries
• Awake Fibreoptic intubation
• Emergency surgical airway:
Cricothyrotomy kit with Seldinger technique
Small cuffed ET via cricothyroid membrane
Tracheostomy

Breathing

• Identify and treat major thoracic injuries :
Pneumothorax (simple,open or tension)
Haemopneumothorax
Rib fractures
Flail chest
• If present then also consider:
Tracheobronchial injury
Cardiac injury (contusion or tamponade)
Pulmonary contusion
Aortic/oesophageal disruption
Diaphragmatic injury

Circulation with haemorrhage control

• Check pulse rate and depth
• Check peripheral perfusion
• 2 large bore IV access
• Send blood for X-match
• Hypotension = hypovolaemia until proven otherwise whereas normotension does not exclude hypovolaemia

Disability

• Initial neurological assessment is limited to level of consciousness using the AVPU scale:
A = Alert
V = responds to Voice
P = responds to Pain
U = Unresponsive
• And observation of pupils
• Any change in AVPU requires reassessment of Airway, Breathing & Circulation

Exposure

• Need to inspect all of patient
• Then cover patient to reduce heat loss