What is a Primary Trauma Survey?
The Primary Trauma Survey (PTS) is a critical first step in the trauma evaluation process. This identifies and manages the impending or actual life threats to the patient. Each part of the primary survey must be completed before progressing, and major trauma patients may require emergency surgery (Gwinnutt & Driscoll, 1996).
The common acronym for performing the Primary Trauma Survey is the ABCDE, with each letter representing an area of focus. The following are the important steps of the Primary Trauma Survey (Planas et al., 2017):
A: Airway assessment with cervical spine assessment
Airway protection is necessary for many trauma patients. To assess the patient's airway, establish if the patient can speak coherently; if they are, the airway is open. If obstruction is identified, performing a chin lift or jaw thrust is important. Throughout this process, the cervical spine must be immobilized and maintained in line to ensure cervical spine precautions. The cervical spine should be stabilized by manually maintaining the neck in a neutral position, in alignment with the body.
B: Breathing and ventilation
Typically, all trauma patients should receive supplemental oxygen. Firstly, it is important to inspect the patient, looking for signs of major chest trauma, such as tracheal deviation or significant chest wounds. Auscultation of both lungs should be conducted to identify asymmetric or decreased lung sounds. Any open chest wounds should be covered immediately with tape on three sides to prevent the entry of atmospheric air into the chest. If a flail chest and respiratory compromise are present, positive pressure ventilation should be provided.
C: Circulation with hemorrhage control
Adequate circulation is required for oxygenation to the brain and other vital organs; blood loss is the most common cause of shock in trauma patients. This is assessed by monitoring the level of responsiveness. This can be quickly assessed by mnemonic AVPU as follows
- A: Alert
- V: Respond to verbal stimuli
- P: Respond to painful stimuli
- U: Unresponsive to any stimuli
Obvious hemorrhaging should be controlled by direct pressure, pale or ashen extremities along with thready pulses in the carotids or femoral arteries are all concerns of hypovolemia. Any patient presenting with cold, pale extremities is classified as in shock until proven otherwise.
D: Disability
A rapid assessment of the patient's neurologic status is necessary on arrival, including checking the patient's conscious state and neurological signs. This is assessed using the Glasgow coma scale (GCS), pupil reaction and size, and lateralizing signs.
E: Exposure and environmental control
Finally, the patient should be completely undressed and exposed to ensure that no injuries are missed. Covering the patient after this and keeping them warm following exposure is crucial to limit the risk of hypothermia.
