Primary Survey (ABCDE)
A — Airway with C-spine protection: jaw thrust (not head tilt) if C-spine injury suspected. B — Breathing: assess chest, auscultate, oxygenate, treat tension pneumothorax. C — Circulation with hemorrhage control: direct pressure, tourniquet, IV access, warmed fluids, blood products. D — Disability: GCS, pupils, glucose. E — Exposure: completely undress, prevent hypothermia (warm blankets, warmed IV fluids).
Secondary Survey
Head-to-toe systematic exam. Head: scalp, eyes (pupils, racoon eyes, Battle's sign), ears (CSF). Neck: trachea midline, JVD, spine tenderness. Chest: symmetric expansion, breath sounds, heart sounds. Abdomen: inspect, auscultate, palpate (guarding, rigidity). Pelvis: stability (do NOT rock repeatedly). Extremities: deformity, swelling, pulses, sensation, motor. Back: log roll, inspect spine.
Trauma Scoring
GCS: Gold standard for head trauma. Revised Trauma Score (RTS): combines GCS, SBP, RR. Injury Severity Score (ISS): based on Abbreviated Injury Scale (AIS) for 6 body regions. Trauma team activation criteria based on mechanism, physiology, and anatomy. ISS >15 = major trauma.
Specific Injuries
Tension pneumothorax: tracheal deviation, JVD, absent breath sounds, hypotension — needle decompression (2nd ICS MCL, then chest tube). Cardiac tamponade: Beck's triad (JVD, muffled heart sounds, hypotension) — pericardiocentesis. Pelvic fracture: pelvic binder, avoid repeat exam. Spinal cord: C-spine immobilization until cleared, neuro checks. Traumatic brain injury: monitor ICP, maintain CPP >60.
Golden Hour
Concept: trauma patients have better outcomes if they reach definitive care within 60 minutes of injury. Includes: scene time, transport, ED assessment, OR. Pre-hospital: minimize scene time, control bleeding, prevent hypothermia. ED: rapid primary survey, damage control resuscitation, early blood products. Damage control surgery: control bleeding, contamination, stabilize.
Important Notes
- Always assume C-spine injury until cleared — use jaw thrust, not head-tilt chin-lift, for airway.
- Hypothermia worsens trauma-induced coagulopathy — "trauma triad of death": hypothermia, acidosis, coagulopathy.
Clinical Tips
- In hemorrhagic shock, permissive hypotension (SBP 80–90 mmHg) until bleeding controlled — less clot disruption.
Summary
Trauma nursing requires systematic ABCDE assessment, rapid identification of life threats, and damage control resuscitation. The golden hour principle drives urgency in trauma care.
