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Primary/Secondary Survey of the Casualty

Primary/Secondary Survey of the Casualty. Objectives. Discuss the importance of the primary/secondary survey Outline how ATLS applies to the casualty. Time of death. Primary/Secondary Survey. Why is it important? What and where are the wounds? What resuscitation is required? Mode of EVAC?.

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Primary/Secondary Survey of the Casualty

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  1. Primary/Secondary Survey of the Casualty

  2. Objectives • Discuss the importance of the primary/secondary survey • Outline how ATLS applies to the casualty

  3. Time of death

  4. Primary/Secondary Survey • Why is it important? • What and where are the wounds? • What resuscitation is required? • Mode of EVAC?

  5. What is the Approach? • ATLS • Created by surgeons for the non-surgeon • Designed in the urban environment • Performed in the hospital setting • Requires a lot of high tech resources • This is our classical training platform • Will this approach work in firefight?

  6. How Do We Develop Our Approach? • What are we going to see? • Injury patterns • Civilian trauma? • Firefight trauma?

  7. How Do We Develop Our Approach? • Civilian trauma • Trimodal death distribution • First peak • Death results in the pre-hospital setting from massive head injury and massive vascular injury. • Second peak • Death in the first few minute of arrival to the hospital and due to massive head, chest and abdominal injury • Third peak • Post resuscitation/operative complications • Firefight Trauma • We don’t know the death distribution • It is believed that if the casualty can arrive alive and relatively stable to the ER…they will live.

  8. How Do We Develop Our Approach? • ATLS • Based on urban injury patterns • Primary Survey • A-Airway/c-spine control • B-Breathing • C-Circulation • D-Disability • E-Exposure • Detailed secondary survey • Head-to-toe exam

  9. How Do We Develop Our Approach? • The Firefight Casualty • Slightly different injury pattern-in this order! • Penetrating extremity trauma • Tension pneumothorax • Loss of airway • Instead of ABCs……think CBAs

  10. The Firefight Casualty Primary Survey • Assess for hemorrhage first • Intervene for life threatening bleed only! • Then, assess for tension pneumothorax • Then, assess for an airway • Utilize a Combitube or surgical airway • Rarely a need for c-spine control

  11. The Firefight Casualty Primary Survey • D-disability- decision to evacuate • E-exposure • Explore ideas on how to expose your casualty while protecting them from the environment • Hypothermia is BAD • Remember, they may need that kevlar!!!

  12. Heat loss during transport

  13. Hypothermia

  14. The Firefight Casualty Secondary Survey • Occurs after you have performed your primary survey and appropriate interventions • Head-to-toe exam along ATLS guidelines. • Be very thorough-many injuries are subtle!

  15. Commonly used acronyms • DCAP-BTLS- deformities, contusions, abrasions, penetrations, burns, tears, lacerations, swelling. • TIC- tenderness, instabilities, crepitus. • TRD- tenderness, rigidity, distension • PMS- pulse, motor, sensory

  16. Head exam • DCAP-BTLS • Pupils • Raccoon/Battle signs • Mid-face instability

  17. Neck exam • Step-off • Tracheal deviation • Jugular vein distention

  18. Chest exam • DCAP-BTLS • TIC • Auscultation • Percussion

  19. Abdominal/Pelvic exam • DCAP-BTLS • TRD-P • Pelvic instability • Priapism • Scrotal/labial hematoma/blood at the meatus

  20. Extremity exam • DCAP-BTLS • TIC • PMS

  21. Posterior Thorax • Log roll casualty • Spine • DCAP-BTLS • Tenderness/step-off • DRE • Gross blood only

  22. Questions?

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