A 40-year-old female is brought in by ambulance after sustaining a high-
speed rollover MVC. She has signs of injury to the head, chest, and abdomen.
What are the first steps in assessing this patient?
ABCDE—assessAirway, Breathing,Circulation, and Disability (mental status).
Expose patient completely, then cover to prevent hypothermia.INITIAL TRAUMA—STABILIZATION AND RESUSCITATIONEXAM/DIAGNOSIS
As with any critically ill patient, the initial assessment of a trauma patient
begins with ABCs. Further assessment and treatment should be directed to
specific complaints or injuries. In a patient with multiple injuries, the
ABCDE approach described by the Advanced Trauma Life Support
(ATLS) guidelines provide a methodical approach to patient assessment
and treatment.
Primary Survey
■ Airway, with C-spine stabilization
■ Breathing and ventilation
■ Circulation and control of bleeding
■ NeurologicDisability (mental status)
■ Exposure of patient
AIRWAY
■ O 2 delivery: High-flow O 2 via a nonrebreather is preferred for patients with
potentially serious injuries.
■ Airway devices/maneuvers (jaw thrust, nasopharyngeal airway, etc.)
■ Intubation for:
■ Altered mental status due to head injury or intoxication
■ Airway compromise due to trauma to the face or neck
■ Significant chest trauma (ie, flail chest)
■ Profound hypotension
■ Maintain C-spine immobilization during intubation.
BREATHING
■ Listen to breath sounds to assess symmetry and an appropriate volume of
air movement.
■ Look for adequate chest rise and fall.
■ A chest X-ray should be obtained in patients with chest pain, evidence of
chest trauma, hypotension, or altered mental status.
CIRCULATION
■ Assess circulation by measuring HR and BP grossly with cap refill and
peripheral pulses followed by a manual BP.
■ There are four classes of hemorrhage (see Table 3.1). Hypotension in
patients with a normal HR is still hypotension and requires both treat-
ment and an aggressive search for blood loss or other cause.
TRAUMAHead injury and thoracic
vascular injury are the two
most common causes of death
in trauma patients.A trauma patient with a
normal RR and O 2 saturation
may require intubation for
immobilization if agitated to
allow imaging or to protect
the airway from anticipated
swelling due to face or neck
trauma or burns.