Trauma Survey
Trauma is a multisystem disorder.  You must develop a systematic method of assessing the trauma patient.

Primary survey - identify all life-threatening conditions. One method is to use ABCDE.  The primary survey is performed at the scene, on admission to the Emergency Department and anytime the patient takes a turn for the worse.

Airway - maintain a patent airway without compromising the cervical spine. 
   Use jaw-lift method to open airway. A cervical injury is assumed until proven
   otherwise.

Breathing - assess the effectiveness of the patient's respirations.  It is best to
   completely expose the chest to assess for open or tension pneumothorax and flail
   chest.  Does the patient need assistance from bag-valve-mask or mechanical
   ventilation?

Circulation - assess carotid, femoral and radial pulses; vital signs; capillary refill.

  •  If carotid pulse is present, the SBP is ³ 40 mm Hg.
  •  If femoral pulse is present, the SBP is ³ 50 mm Hg.
  •  If radial pulse is present, the SBP is ³ 60 mm Hg.

    If the capillary refill is delayed, suspect hypovolemic shock.

Disability - a rapid neurological exam is completed, including the Glascow
   Coma Scale, pupil size and response, and motor function.  Rectal sphincter tone
   is assessed to determine spinal cord function.

Exposure - remove any wet clothing. Consider if the patient was exposed to
   prolonged heat or cold.  Remember, if the patient is uncovered and massive
   amount of room temperature fluid is administered, the patient is at risk for
   hypothermia.

Secondary survey - this is performed once the patient is stabilized and identifies all injuries.  The secondary survey is also performed when the patient is transferred to a floor (ICU or other). Nine per cent of injuries are missed in the primary and secondary surveys. The mnemonic for the secondary survey is AMPLE. In addition every inch of the patient needs to be examined - including hair. Head lacerations have been missed for as much as 48 hours when a thorough scalp examination is not doen.

Allergies - ask about all allergies - food, medicine, plants, animals, pollen, latex

Medication - ask about all the medicines the patient takes (over the counter,
    prescription, herbal) and if the medicine was taken today.

Pre-existing conditions

Last meal - important to know if the patient goes to surgery

Events immediately preceding injury or related to the injury



Sharon Kumm, University of Kansas School of Nursing, August 1999
Revised 2003