Emergency Medicine Book

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Secondary Trauma EvaluationAka: Trauma Secondary Survey

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  1. Head Evaluation
    1. Assess Eyes early (may be difficult after face edema)
      1. Visual Acuity
      2. Pupil size and pupil reactivity
      3. Conjunctival hemorrhage
      4. Retinal hemorrhage
      5. Hyphema
      6. Penetrating injury
      7. Contact lenses
      8. Lens Dislocation
    2. Pitfalls
      1. Eye Injury as above
      2. Head Injury
      3. Posterior scalp Laceration
  2. Maxillofacial Pitfalls
    1. Pending airway obstruction or airway status changes
    2. Cervical Spine Injury
    3. Exsanguination from mid-face Fracture
    4. Lacrimal duct Laceration
    5. Facial Nerve injury
  3. Cervical Spine Evaluation
    1. Assess for Cervical Spine Injury
      1. Initial: Cross Table Lateral XRay
      2. Full Cervical Spine XRay: Open Mouth Odontoid, PA
    2. Pitfalls
      1. Cervical Spine Injury
      2. Esophagus, trachea, or larynx injury
      3. Carotid injury
  4. Chest Pitfalls
    1. Tension Pneumothorax
    2. Open chest wound
    3. Flail chest
    4. Cardiac Tamponade
    5. Aortic Rupture
  5. Abdomen and Genitourinary Pitfalls
    1. Liver, Spleen, Kidney, or Pancreas injury
    2. Hollow viscus or lumbar spine injury
      1. Seat Belt
      2. Deceleration injury
    3. Pelvic Fracture
    4. Urethral Injury
    5. Rectal Injury
    6. Vaginal Injury
    7. Bladder injury
  6. Musculoskeletal Pitfalls
    1. Spine Fracture
    2. Pelvic Fracture
    3. Digital Fracture
    4. Fracture with vascular compromise
    5. Compartment Syndrome
      1. Observe for Paresthesias or pain on passive ROM
      2. Measure Tissue Pressure (over 25mmHg is abnormal)
      3. Nerve injury
        1. Motor
          1. Ulnar Nerve: Claw Hand
          2. Radial Nerve: Wrist drop
          3. Median Nerve: Cannot make OK Sign
          4. Peroneal Nerve: Foot drop
            1. Consider Anterior Tibial Compartment Syndrome
        2. Sensory
          1. Radial Nerve: thumb web space
          2. Median Nerve: distal index
          3. Ulnar Nerve: distal pinky
  7. Neurologic Assessment
    1. Assign Glasgow Coma Scale score
    2. Increased Intracranial Pressure
    3. Subdural Hematoma
    4. Epidural hematoma
    5. Depressed skull Fracture
    6. Spine injury
    7. Check Sensory levels affected
      1. Use syringe filled with Alcohol
      2. Spray skin at each dermatome level
      3. Patient should feel cold sensation
    8. Steroid Indications
      1. Spinal Trauma
      2. Not indicated for intracranial swelling
  8. Skin
    1. See Burn Injury
  9. Medications
    1. Codeine IM may be used for anesthesia
    2. Check with neurosurgeon prior to anesthetic
  10. Reference
    1. (1993) Advanced Trauma Life Support ({a :
    2. Student Manual, American College of Surgeons

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