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Predicated on the concepts of rapid triage, diagnosis, resuscitation, and therapeutic intervention. Evaluation of trauma is categorized by two main surveys:
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Primary survey (ABCDE):
Airway: Establish and ensure a clear airway.
Breathing: Ventilate with 100% O2 and check for breathing compromise.
Circulation: Apply pressure to sites of external bleeding, place two large-bore IV lines, assess blood volume status, and begin fluid resuscitation if signs of hypovolemia.
Disability: Document functional status and perform a brief neurologic examination.
Exposure: Completely disrobe the patient and logroll to inspect the back.
Secondary survey:
Perform a head-to-toe examination to search for other injuries and set further priorities.
May include trauma series imaging, focused assessment with sonography in trauma (FAST), Foley catheter or gastric tube placement, splinting of unstable fractures/dislocations, tetanus prophylaxis, surgical consultation, and medications.
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MNEMONIC
Primary survey:
ABCDE
Airway
Breathing
Circulation
Disability
Exposure
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Contributes to about one-third of all injury deaths. Traumatic brain injury can result from direct injury caused by the force of an object striking the head or indirect injury from acceleration/deceleration forces. Use the Glasgow Coma Scale (GCS) to assess all patients with head trauma (Table 18.1).
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KEY FACT
Headache is a common complaint in the ED and urgent care setting. Structural headaches due to head trauma, causing space-occupying hematomas and elevation of ICP, are considered neurosurgical emergencies.
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Low-risk injuries: Characterized by minor trauma, scalp wounds, a GCS score of 15, normal neurologic exam, and absence of signs of intracranial injury.
Moderate- to high-risk injuries: Characterized by altered mental status or loss of consciousness, persistent nausea and vomiting, seizures, severe headaches, focal neurologic signs, presence of penetrating ...