1. Airway: normal voice ensures an adequate airway

2. Breathing: assessment of neck veins is initial assessment

3. Circulation: level of consciousness, skin color, pulse rate

4. Neuro: AVPU and Glasgow Coma scale

5: Exposure: check EVERYWHERE for injury, undress patient completely

Identify the critical diagnoses for each phase of the trauma evaluation

1. Airway: Airway obstruction

2. Breathing: Tension pneumothorax, massive hemothorax, sucking chest wound, and flail chest

3. Circulation: Massive hemothorax, Intraabdominal hemorrhage, cardiac tamponade, external hemorrhage

4. Neuro: Coma, Disability

Airway obstruction

tongue, blood, vomit, foreign bodies, injury

   a. intervention: jaw thrust (best) and chin lift/head tilt

      - oral/nasal airway

- endotracheal intubation with in-line stabilization

      - Cricothyrotomy

Tension pneumo

Massive Hemothorax

Sucking chest wound

Flail chest

JVD, tracheal deviation to contralateral side, absent breath sounds, tympany to percussion.

a. treatment: needle decompression:

insert 12-14 G needle into 2-3^rd intercostal space at midclavicular line as well as chest tube placement

tachycardia, hypotension decreased/absent breath sounds, dullness to percussion, chest X-ray.

    a. treatment: insert chest tube. If > 1500 ml blood or 300 ml/h a thoracotomy is required.

open pneumothorax with 2/3 diameter of trachea

    a. treatment: occlusive dressing taped on 3 sides followed by a chest tube

chest lacks bony continuity with surrounding chest wall (broken ribs). Identified by paradoxical motion of the chest wall with inspiration.

    a. treatment: chest tube

Massive hemothorax

Intra-ab hemorrhaging

Cardiac Tamponade

External Hemorrhage

Shock

spleen and liver are most common origins

impairing right ventricular filling and decreasing CO.

   - Beck’s triad: hypotension, distended neck veins, muffled heart tones

   - Echo

    a. treatment: IV fluids, pericardiocentesis

a. treatment: IV access with two large bore peripheral IV’s

       - direct pressure to sites of hemorrhage

       - 2 L NS IV and blood transfusion if no response to IVF

usually hemorrhagic but can be non-hemorrhagic (pneumothorax, cardigenic, neurogenic). First sign of shock is coolness and tachycardia.

     a. treatment: Re-establishing perfusion to the organs is the primary goal

-restoring and maintaining the blood circulating volume

-ensuring oxygenation and blood pressure are adequate

-achieving and maintaining effective cardiac function

-preventing complications

- AVPU: Alert, respond to Verbal, respond to Painful stimulus, Unresponsive

    - Glascow Coma: Motor, verbal, eye opening

         - <8 is bad

1. Hypothermia: warm blankets.

2. Logroll with c-spine immobilization