MULTIPLE INJURIES

Surgical Emergencies 219

7 The time-honoured mnemonic for the initial sequence of care is ABCDE (see

Table 8.1).

IMMEDIATE MANAGEMENT

1 Airway

(i) Assess the airway to ascertain patency and identify potential

obstruction:

(a) clear the airway of loose or broken dentures and suck out any

debris

(b) insert an oropharyngeal airway if the patient is unconscious

(c) give 100% oxygen by tight-fitting mask with reservoir bag

(d) aim for an oxygen saturation above 94%.

(ii) Intubation

(a) a definitive procedure to protect and maintain the airway is

indicated if the patient is unconscious, or has a reduced or

absent gag reflex

(b) take great care to minimize neck movements in the

unconscious head injury or suspected neck injury by

maintaining in-line manual immobilization during airway

assessment and endotracheal intubation

(c) rapid sequence induction (RSI) intubation

• this is the airway technique of choice, provided the operator
  is skilled in the technique


• confirm correct tube placement using capnography to
  measure end-tidal carbon dioxide (ETCO 2 ) (see p. 467).

(iii) Surgical airway: proceed directly to cricothyrotomy if

endotracheal intubation is impossible due to laryngeal injury or

severe maxillofacial injury (see p. 469).

Table 8.1 Mnemonic for initial sequence of care of the multiply-injured patient
during the primary survey and resuscitation phases

A Airway maintenance with cervical spine control

B Breathing and ventilation

C Circulation with haemorrhage control

D Disability: brief neurological evaluation

E Exposure/environmental control: completely undress the

patient, but prevent hypothermia

Warning: never attempt RSI unless you have been trained. Use a bag-valve

! mask technique instead while awaiting help.