EMERGENCY SURGICAL PROCEDURES
Trauma is the leading cause of death in the first four decades of life. It is
surpassed only by cancer and atherosclerosis as the cause of death in all age groups.
The statistics surrounding the impact of trauma on human life and financial resources is
staggering. Fifty million injuries occur annually in the United States (US), ten million of
which are disabling. In the 15 to 24 age group, trauma accounts for 50 percent more
deaths in the US than any other industrial society in the world. As with most critical
illnesses, the initial observations and treatments influence the ultimate outcome for the
severely traumatized patient. Specific knowledge of basic treatment principles for
specific injury types such as head, chest, abdominal, and spinal injuries can significantly
improve the patient's possibility of recovery.
INITIAL ASSESSMENT AND MANAGEMENT
There are two phases in an initial assessment and management of a trauma
patient: the primary survey and the secondary survey. Both surveys are performed
a. Primary Survey: General. The primary survey is designed to identify and
manage life-threatening conditions of a trauma patient. In this survey, a trauma patient
can be assessed, and management of his conditions can be performed in roughly two
minutes. As the patient's life-threatening problems are identified, treatment should be
started. DO NOT wait until the complete survey is done before beginning treatment.
The primary survey begins with the ABCs: check the Airway, check his Breathing, and
check his Circulation. Conduct the primary survey in this manner:
b. Primary Survey: A--Airway Maintenance and C-spine. The first step in
the primary survey is to assess the patient's airway. Until proven otherwise, assume a
trauma patient with an injury above the clavicle (collarbone) has a cervical spine injury.
With this in mind, DO NOT hyperextend the patient's head or neck.
Look, listen, and feel the patient to determine if his airway is open.
If you must open the patient's airway, use the chin-lift or jaw-thrust