The first step in any trauma assessment is the primary survey. | Surgery videos & books

The first step in any trauma assessment is the primary survey. This consists of: A—airway maintenance B—breathing and ventilation C—circulation D—disability/neurologic status E—exposure/environment The first priority in any trauma patient is to establish an airway. In an unconscious patient with decreased saturations, endotracheal intubation is indicated. While facial lacerations may indicate fractures, these patients can often be successfully orally intubated. This should be attempted first, but if this technique is unsuccessful, a cricothyroidotomy should be performed to secure the airway. Once an airway has been established, you can address breathing/ ventilation by auscultating breath sounds and evaluating for end-tidal CO2 using a capnometer. It is at this point where a life-threatening tension pneumothorax can be identified and treated. The next step is to evaluate the circulation. This includes getting adequate intravenous access. The patient described has two large-bore IVs, which should be sufficient for the initial resuscitation. Central venous access is indicated only if adequate access cannot be established peripherally. It is here that evaluation for intra-abdominal hemorrhage can be conducted using ultrasound or diagnostic peritoneal lavage.