What’s your name? What happened?
100% O2 non-rebreather, pulse ox, cardiac monitor, BP, two large bore IVs
Page lab, routine trauma labs including type & screen
Airway
Open or closed
Protect c-spine
Assess trachea, trauma, masses, stridor
Anticipate problems (mass effect, burns) and call for help and/or intubate preemptively
Chin lift, jaw thrust
Oropharyngeal airway; may try nasopharyngeal if no facial trauma
LEMON: Look externally (atypical jaw, hair, obesity); Evaluate 3-3-2 rule; Mallampati; Obstruction; Neck mobility
Intubate, LMA, king airway or surgical
Suction
Consider OG tube if last meal recently (NG may be ok if no head trauma)
Breathing
Jugular vein appearance
Breath sounds
Visually inspect chest
Percuss thorax
Oxygen saturation
Blood gas (want PaO2 > 70 mmHg)
CXR
Consider high cervical fracture w/phrenic nerve lesion
Occlude open pneumothoraces
Chest tubes as needed
If tolerating OPA patient will need intubation
Circulation
Patient’s color
Extremities warm or cold
HR and BP
Heart sounds
Examine for bleeding or deformities, don't forget scalp, back, PR, PV
EKG
Examine chest; CXR
Examine abdomen; FAST or DPL
Examine pelvis; Pelvic XR
Examine long bones
CT if stable
Call surgery as soon as there's an indication
IV NS/LR/blood as needed depending on severity of shock
Place foley to assess resuscitation/perfusion
Disability
Eye exam
GCS
Focal neurological deficit
Exposure and environmental control
Undress patient completely and apply warm blankets
Secondary survey
Head to toe exam
AMPLE history
Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.