This involves visual inspection of the patient's chest, looking for injury. Once the airway is secured or maintained by the patient, breathing and ventilation should be assessed. If the patient requires intubation, be sure that the endotracheal tube remains secure as accidental extubation is a leading cause of morbidity in trauma patients. If intubating cervical spine immobilization must be maintained. If unable to intubate, cricothyrotomy should be performed. If the patient is unconscious or not protecting their airway, they should be intubated immediately. When inspecting and palpating the patient, look for oral or dental injury, obstructions to intubation, such as unstable midface fractures, and even location for possible cricothyrotomy. Look for signs of respiratory distress, listen for stridor, inspect the face, oral cavity, and neck, as well as palpate the patient's neck and face. Airway evaluation also includes a visual inspection of the patient. This will help assess the patency of the airway. Ask the patient their name to see if they respond clearly and appropriately. Assessing the conscious patient's airway starts with talking to the patient. Advanced Trauma Life Support (ATLS), developed by the American College of Surgeons, promotes the primary survey sequence as airway, breathing, circulation, disability, exposure (ABCDE).Īirway obstruction is a major, preventable cause of death in trauma victims, and therefore it is the initial step of the primary survey. If this occurs, every effort should be made to obtain the pertinent information from EMS before their departure. Depending on the patient's condition, the primary survey may have to start during the EMS presentation. Upon patient arrival, the room should be quiet, and EMS should briefly present the patient and their findings. Additional equipment and interventions might also be required beyond those anticipated by the prearrival report, and having ready access to additional resources is also important. It is important to prepare equipment needed for intubation, cardiac monitoring, intravenous access, or intraosseous access, and any other intervention that may be indicated by the initial information received. With the initial information provided by emergency medical services (EMS) and the team assembled, all equipment should be gathered and prepared. The team leader should assign the roles and be in charge of the direction and decision making upon patient arrival and throughout the assessment. Other roles may include documentation, airway management, IV access, attaching monitoring devices, and medication administration. There must be one individual assigned as a team leader, usually the physician. Once the team is present, and ideally before the patient arrives, roles should be assigned. The trauma team may vary based on the hospital location and staffing but should, at a minimum, include a physician and nurse. After receiving this information, the healthcare team members should begin thinking of possible injuries that may be a threat to the patient's life. Emergency medical services (EMS) should provide information including mechanism of injury, patient vital signs, obvious injury, current interventions, and patient's age and sex if available. This includes gathering the care team, equipment, and initial information. The first step in trauma assessment begins prior to the patient's arrival.
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