Trauma Assessment
Simplified: Primary
(ABCDE) and
Secondary Survey
Review
,1. Introduction
Trauma is a leading cause of morbidity and mortality worldwide. In emergency
nursing, rapid, systematic assessment is the key to preventing death and long-
term complications. The cornerstone of trauma care is the ABCDE approach
(Airway, Breathing, Circulation, Disability, Exposure) for the primary survey,
followed by a secondary survey for a thorough head-to-toe evaluation.
Why ABCDE is critical:
• Life-threatening conditions are identified and managed immediately.
• Systematic approach reduces omissions under stress.
• Provides a common language for trauma teams.
Emergency Nursing Goals:
1. Rapid stabilization of life-threatening injuries.
2. Prioritize interventions according to patient condition.
3. Facilitate diagnostic testing and definitive care.
4. Educate family and provide psychosocial support.
Core Principles:
• Time-critical: Primary survey should be completed in under 5 minutes for
unstable patients.
• “Treat as you go”: Intervene while assessing—don’t wait until the survey is
complete.
• Maintain airway, oxygenation, circulation first; other injuries come later.
2. The Primary Survey (ABCDE)
The primary survey is a rapid assessment designed to identify immediate life
threats. Each step is assessed in sequence, with simultaneous interventions.
,A: Airway with Cervical Spine Protection
Goal: Ensure airway patency and prevent aspiration; protect cervical spine in
trauma patients.
Assessment:
• Check if patient is talking or making sounds.
• Look for airway obstruction: blood, vomit, teeth, foreign objects, swelling.
• Assess for stridor, gurgling, or hoarseness (indicates partial obstruction).
Interventions:
• Open airway: Jaw-thrust maneuver (preferred if cervical spine injury
suspected), or chin-lift if no spine injury.
• Suction: Clear secretions immediately.
• Airway adjuncts: Oropharyngeal (OPA) or nasopharyngeal (NPA) as
appropriate.
• Definitive airway: Endotracheal intubation for inability to maintain airway
or GCS < 8.
• Cervical spine protection: Manual in-line stabilization; cervical collar; log-
roll patient only when safe.
Nursing Pearls:
• Always assume cervical spine injury in trauma.
• Monitor oxygen saturation continuously.
• Prepare for rapid sequence intubation if airway is compromised.
B: Breathing and Ventilation
Goal: Ensure adequate oxygenation and ventilation; identify injuries like
pneumothorax or hemothorax.
Assessment:
• Observe chest movement symmetry.
•
, • Check respiratory rate, depth, and effort.
• Inspect for penetrating injuries, flail chest, contusions, bruising.
• Auscultate breath sounds.
• Palpate for subcutaneous emphysema or tracheal deviation.
Interventions:
• Administer high-flow oxygen.
• Correct life-threatening conditions immediately:
o Tension pneumothorax → needle decompression.
o Open pneumothorax → occlusive dressing (three-sided).
o Massive hemothorax → chest tube insertion.
• Monitor SpO₂, arterial blood gases if available.
• Consider non-invasive ventilation if appropriate (CPAP, BiPAP) in stable
patients.
Nursing Pearls:
• Reassess breathing frequently; trauma patients can deteriorate rapidly.
• Document interventions and patient response.
• Be ready to escalate airway support if oxygenation fails.
C: Circulation with Hemorrhage Control
Goal: Identify and manage shock; control external bleeding; ensure adequate
perfusion.
Assessment:
• Check pulse rate, quality, and rhythm.
• Measure BP and mean arterial pressure (MAP).
• Inspect for external bleeding, pallor, cool/clammy skin.
• Assess capillary refill.
• Look for signs of internal bleeding: distended abdomen, flank bruising,
pelvic instability.
Interventions:
• Control external bleeding: direct pressure, tourniquet if necessary.
Simplified: Primary
(ABCDE) and
Secondary Survey
Review
,1. Introduction
Trauma is a leading cause of morbidity and mortality worldwide. In emergency
nursing, rapid, systematic assessment is the key to preventing death and long-
term complications. The cornerstone of trauma care is the ABCDE approach
(Airway, Breathing, Circulation, Disability, Exposure) for the primary survey,
followed by a secondary survey for a thorough head-to-toe evaluation.
Why ABCDE is critical:
• Life-threatening conditions are identified and managed immediately.
• Systematic approach reduces omissions under stress.
• Provides a common language for trauma teams.
Emergency Nursing Goals:
1. Rapid stabilization of life-threatening injuries.
2. Prioritize interventions according to patient condition.
3. Facilitate diagnostic testing and definitive care.
4. Educate family and provide psychosocial support.
Core Principles:
• Time-critical: Primary survey should be completed in under 5 minutes for
unstable patients.
• “Treat as you go”: Intervene while assessing—don’t wait until the survey is
complete.
• Maintain airway, oxygenation, circulation first; other injuries come later.
2. The Primary Survey (ABCDE)
The primary survey is a rapid assessment designed to identify immediate life
threats. Each step is assessed in sequence, with simultaneous interventions.
,A: Airway with Cervical Spine Protection
Goal: Ensure airway patency and prevent aspiration; protect cervical spine in
trauma patients.
Assessment:
• Check if patient is talking or making sounds.
• Look for airway obstruction: blood, vomit, teeth, foreign objects, swelling.
• Assess for stridor, gurgling, or hoarseness (indicates partial obstruction).
Interventions:
• Open airway: Jaw-thrust maneuver (preferred if cervical spine injury
suspected), or chin-lift if no spine injury.
• Suction: Clear secretions immediately.
• Airway adjuncts: Oropharyngeal (OPA) or nasopharyngeal (NPA) as
appropriate.
• Definitive airway: Endotracheal intubation for inability to maintain airway
or GCS < 8.
• Cervical spine protection: Manual in-line stabilization; cervical collar; log-
roll patient only when safe.
Nursing Pearls:
• Always assume cervical spine injury in trauma.
• Monitor oxygen saturation continuously.
• Prepare for rapid sequence intubation if airway is compromised.
B: Breathing and Ventilation
Goal: Ensure adequate oxygenation and ventilation; identify injuries like
pneumothorax or hemothorax.
Assessment:
• Observe chest movement symmetry.
•
, • Check respiratory rate, depth, and effort.
• Inspect for penetrating injuries, flail chest, contusions, bruising.
• Auscultate breath sounds.
• Palpate for subcutaneous emphysema or tracheal deviation.
Interventions:
• Administer high-flow oxygen.
• Correct life-threatening conditions immediately:
o Tension pneumothorax → needle decompression.
o Open pneumothorax → occlusive dressing (three-sided).
o Massive hemothorax → chest tube insertion.
• Monitor SpO₂, arterial blood gases if available.
• Consider non-invasive ventilation if appropriate (CPAP, BiPAP) in stable
patients.
Nursing Pearls:
• Reassess breathing frequently; trauma patients can deteriorate rapidly.
• Document interventions and patient response.
• Be ready to escalate airway support if oxygenation fails.
C: Circulation with Hemorrhage Control
Goal: Identify and manage shock; control external bleeding; ensure adequate
perfusion.
Assessment:
• Check pulse rate, quality, and rhythm.
• Measure BP and mean arterial pressure (MAP).
• Inspect for external bleeding, pallor, cool/clammy skin.
• Assess capillary refill.
• Look for signs of internal bleeding: distended abdomen, flank bruising,
pelvic instability.
Interventions:
• Control external bleeding: direct pressure, tourniquet if necessary.
