• History

• Physical examination: head-to-toe, ‘tubes and fingers in every orifice’

• Complete neurological examination

• Special diagnostic tests

• Re-evaluation

History

¨ A Allergies

¨ M Medications

¨ P Past illnesses

¨ L Last meal

¨ E Event / environment

Head examination

• Complete neurological exam

• GCS Score determination

• Comprehensive eye/ear exams

• Pitfalls: Unconscious patient, periorbital oedema, occluded auditory

Maxillofacial examination

• Bony crepitus/ stability

• Palpable deformity

• Pitfalls: Potential airway obstruction, cribiform plate fracture

Cervical Spine

• Palpate for tenderness

• Complete motor/sensory examination

• Reflexes

• C-spine imaging

• Pitfalls: Altered LOC for any reasons, other painful injuries

Neck (Soft Tissues)

• Mechanism: Blunt vs. penetrating

• Symptoms: Airway obstruction, hoarseness

• Findings: Crepitus haematoma, strider, bruit

• Pitfalls: Delayed symptoms and signs, progressive airway obstruction, occult injuries

Chest

• Inspect, palpate

• Auscultate, percuss

• Radiographs

• Pitfalls: Elderly and children

Abdominal Evaluation

• Inspect, auscultate, palpate, percuss

• Re-evaluate frequently

• Special studies

• Pitfalls: Hollow viscous and retroperitoneal injuries, excessive pelvic manipulation

Perineum

• Perineum: Contusions, haematomas, lacerations, urethral blood

• Rectum: Sphincter tone, high-riding prostate, pelvic fracture, rectal wall integrity

• Vagina: Blood, lacerations

• Pitfalls: Urethral injury in women, pregnancy

Musculoskeletal and Extremities

• Contusion, deformity

• Pain

• Perfusion

• Peripheral neurovascular status

• Radiographs as required

Musculoskeletal: Pelvis

• Pain on palpation

• Symphysis width

• Leg length uneven

• Instability

• Radiographs as needed

• Pitfalls: Potential blood loss, missed fractures, soft tissues or ligamentous injury, occult compartment syndrome ( especially with altered LOC/ hypotension)

Neurological examination

• Complete motor and sensory exams

• Imaging as indicated

• Reflexes

• CNS: Frequent re-evaluation, prevent secondary brain injury, early neurosurgical consultation

• Pitfalls: Incomplete immobilization, rapid deterioration, subtle increase in intra-cranial pressure with manipulation

Re-evaluation

• Minimizing missed injuries

• High index of suspicion

• Frequent re-evaluation and monitoring

Trauma Management: Primary Survey