MD Notes

creation date: 2026-02-24 13:29
tags: Assessments

Trauma Assessment

Prehospital

Prior to arrival to the emergency department, EMS will provide information:

  • Mechanism of injury
  • Patient vitals
  • Patient age and sex
  • Any obvious injury
  • Current interventions

Emergency department staff should establish roles:

  • Team lead (usually physician)
  • Documentation
  • Airway management
  • IV access
  • Attachment of monitoring devices
  • Medication assessment

Primary Survey

Upon arrival, EMS will present the patient and their findings. Primary survey may start during presentation depending on condition. ATLS organizes the primary survey into the sequence ABCDE.

Airway
Assess by:

  • Talking to patient
  • Inspecting patient for signs of respiratory distress, listening for stridor
  • Inspecting the face, oral cavity, and neck
  • Palpating the neck and face

Note any oral or dental injury, obstructions to intubation, unstable midface fractures. It may be beneficial to assess the location for possible cricothyrotomy.

If a patient is unconscious or not protecting their airway, they should be intubated immediately or cricothyrotomy be performed if intubation is not possible. C-spine immobilization should be maintained with intubation.

Breathing
Assessment of breathing and ventilation is by visual inspection of patient’s chest.

  • Inspect for injury
  • Inspect for paradoxical chest movement (indicates flail chest, penetrating injury, tracheal deviation)
  • Auscultate for decreased breath sounds
  • Palpate for signs of crepitus
  • Evaluate oxygen saturation

Signs of tension pneumothorax indicates needle decompression. Ultrasound or chest x-ray may be considered.

Circulation
Circulation involves assessment of hemorrhage and perfusion. The five major locations to access are the thorax, peritoneal cavity, pelvic/long bone fractures, and externally

This involves:

  • Inspection for external hemorrhage
  • Inspection for signs of shock
  • Palpation of carotid and femoral pulses
  • Assessment of skin (for cold and diaphoresis)

In cases of external bleeding:

  • Apply direct pressure
  • Apply tourniquet if arterial bleed at an extremity

The Extended Focused Assessment with Sonography in Trauma (eFAST) can be used to assess for intra-abdominal hemorrhage.

Two large-bore peripheral IVs should be established. If that is not possible, IO access should be established.

In patients with shock, fluids or blood products are used (depending on concern of hemorrhage). Anticoagulation may have to be reversed.

Disability
Once ABCs have been evaluated and stabilized, the patient’s neurologic function should be assessed. This is done using the GCS scale.

For GCS ≤8, consider definitive airway control.

Exposure
Clothing should be removed and assess for signs of injury such as gunshot wounds, stab wounds, abrasions, lacerations, ecchymosis, or any other traumatic findings.

Be cautious of hypothermia with the removal of clothes.

Secondary Survey

Once the patient has been stabilized and immediate surgical intervention is unnecessary, a secondary survey is performed.

This consist of:

  • History from patient (if possible)
  • Thorough head-to-toe exam
  • Diagnostic testings

Specific history may be relevant based on the mechanism of injury (eg. seatbelt use or height of fall).

C-Spine Immobilization

The C-spine can be clinically cleared in some circumstances without imaging. The Canadian c-spine rule guides whether c-spine immobilization/collar can be removed.

To clinically clear the c-spine:

  1. The patient must not:
    • Be age ≥65
    • Have extremity paresthesia
    • Experienced a dangerous mechanism (fall ≥3 ft/5 stairs, axial load injury, high speed MVC, bicycle collision, motorized recreational vehicle)
  2. The patient should be:
    • Sitting in the ED
    • Ambulatory at any time
    • Have delayed (non-immediate onset) neck pain
    • Without midline tenderness
    • Able to actively rotate next 45 degrees left and right

If these conditions are met, further cervical imaging is unnecessary and the patient can have their collar removed. Consider leaving the patient in the collar if they are inebriated.

References

Tools / Guidelines

MDCalc - Canadian C-Spine Rule

Additional Reading

Backlinks