Primary survey

Assessment of airway

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

Airway Procedures

* 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 - Intubation

Airway Procedures - Intubation

* 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

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 - other

Airway Procedures - other

* 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

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

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

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

Exposure

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