Approach to trauma patient

Preparation

Before the patient's arrival, prepare for trauma resuscitation.

Mobilize the trauma team

• Activate the medical emergency team.

Prepare equipment

Ensure the availability of:

• Patient monitors

• Ultrasound machine

• Airway equipment

• Intravenous access equipment

• Resuscitation equipment

Consider high-risk mechanisms of injury

The following mechanisms are associated with severe trauma:

• High-speed motor vehicle collision

• Pedestrian struck by a vehicle

• Ejection from a vehicle

• Fall from a height greater than 3 metres

• Penetrating injuries

Initial resuscitation (primary survey)

Airway

• Ensure airway patency.

• Protect the airway as appropriate.

• Maintain cervical spine immobilization throughout airway management.

Breathing

• Administer supplemental oxygen and titrate to maintain SpO₂ above 92%.

• If there is absent air entry or hyper-resonance on examination, insert a chest drain.

• If the patient has signs of obstructive shock or tracheal deviation suggestive of tension pneumothorax, perform immediate needle decompression followed by definitive chest drain insertion.

Circulation

• Insert two large-bore intravenous cannulas.

• Resuscitate with crystalloid fluids according to blood pressure.

• If there is inadequate response to crystalloid therapy, transfuse blood.

• Control all external bleeding immediately.

Disability

• Assess the Glasgow Coma Scale (GCS) and document findings regularly.

• Perform a brief neurological examination.

• Assess pupillary responses.

• Check random blood glucose (RBG).

Exposure

• Fully expose the patient to identify all injuries.

• Prevent hypothermia throughout assessment and resuscitation.

Secondary survey

Perform a systematic head-to-toe examination.

Head, eyes, ears, nose, and throat (HEENT)

Assess for:

• Scalp hematomas

• Depressed skull fractures

• Facial bone tenderness

• Eye injuries

• Otorrhea

• Hemotympanum

• Tracheal deviation

Spine

• Log-roll the patient while maintaining spinal precautions.

• Palpate the cervical, thoracic, and lumbar spinous processes.

• Assess for tenderness or step deformities.

Chest

Perform inspection, palpation, and auscultation.

Assess for:

• Pneumothorax

• Hemothorax

• Rib fractures

• Flail chest

If ventilation or oxygenation is inadequate, consider non-invasive ventilation (NIV) or endotracheal intubation.

Pelvis

• Carefully assess for pelvic ring instability.

• If pelvic fracture is suspected, apply a pelvic binder (or sheet).

Abdomen

• Examine all abdominal quadrants for guarding, tenderness, and bruising.

• Perform a Focused Assessment with Sonography for Trauma (FAST) examination in all trauma patients.

Extremities

Assess all limbs for:

• Bony injuries

• Compartment syndrome

• Muscle or soft tissue injuries

• Neurological deficits

• Neurovascular compromise

Trauma checklist before leaving the Emergency Department

Before transfer from the Emergency Department, confirm that:

• Airway is patent or adequately protected.

• Tension pneumothorax or hemothorax has been excluded or treated.

• SpO₂ is greater than 92%.

• Large-bore intravenous access has been established and appropriate fluid resuscitation initiated.

• External bleeding has been controlled.

• Pelvic fracture assessment has been completed.

• Assessment for internal bleeding has been performed.

• Spinal immobilization has been maintained.

• Neurovascular status of all limbs has been assessed.

• The need for a chest tube, nasogastric tube (NGT), or urinary catheter has been assessed.