7-5
pain, preferably through the intravenous route (see Procedure: Pain Assessment and Control).
Antibiotics: There are many antibiotic regimens. A reasonable approach is to use cefotetan 1-2 grams IV
q12 hrs, IV or IM. It is cheap, readily available, easily stored and rarely causes an allergic reaction. Minor
injuries in the field often become infected so pre-hospital antibiotic use should be liberal. Of course all open
fractures, abdominal wounds and extensive soft tissue injury should be cleaned, dressed and given antibiotics
(see Appendices: Organism/Antibiotic Chart)
Reassessment: The most valuable diagnostic tool available to the SOF medic while caring for combat
casualties is a repeated physical exam. Patients should be frequently reassessed with attention given to
potential complications of their particular injuries and treatments. For example, distal pulses and sensation
should be re-examined in those patients with extremity injuries looking for the development of compartment
syndrome. Wounds treated with bandages and tourniquets should be reassessed for further bleeding.
Patients with head injures should have frequent neurological examinations looking for signs of deterioration.
Those with chest wounds will require repeated auscultation to rule development or re-accumulation of a
pneumothorax.
Trauma: Primary/Secondary Survey Checklist
Furnished by JSOMTCScene Size-Up
Tactical Situation/Security/Time on Site
Body Substance Isolation (BSI) Precautions
Mechanism of Injury (MOI)/History of Events
Determine # of Patients
Request Help if needed
Direct/Provide C-spine Stabilization if indicated (always if multisystem trauma, altered LOC or blunt injury
above clavicle)
Primary Survey
INITIAL ASSESSMENT
AVPU/GCS (GCS of 8 or less requires intubation)
Chief Complaint if Conscious
Determine Apparent Life Threats (Massive Hemorrhage)/Stop Gaps
ASSESS AIRWAY
Assess Airway for 5-10 Seconds
Open Airway/Modified Jaw Thrust/Chin Lift
Inspect Mouth and Clear (Suction/Heimlich/Laryngoscope)
Insert Indicated Airway Adjunct (NPA/OPA/ET/CRIC)
Reassess Airway/BLS as Required
ASSESS BREATHING
Inspect Anterior Chest (bilateral rise and fall)
Occlude Chest Wounds
Auscultate Anterior Chest X1 bilateral
Palpate Anterior Chest
Percuss Anterior Chest X1 bilateral
Palpate Posterior Chest
Identify/Stop Gap Treat Posterior Wound
Manage Injuries that Could Complicate Breathing
ASSESS CIRCULATION
Identify and Control Major Bleeding Pack, Clamp, Dress PRN
Apply Tourniquet PRN (Amputation, Major Bleeding)
Assess Pulse (Radial/Femoral/Carotid)
Assess Peripheral Perfusion (Skin Color/Temp)
State General Impression of Patient Based on Injuries/Findings