e. Primary Survey: D--Disability/ Neurologic Status. To the usual ABCs, a D
has been added. This is the evaluation of the patient's disability and neurologic status.
Perform this evaluation in this manner.
(1) Level of consciousness. Check the patient's level of consciousness.
Use the AVPU method for a fast overview of his level of consciousness.
V--Responds to Vocal stimuli.
P--Responds to Painful stimuli.
The patient should be completely undressed to make a thorough examination
Resuscitation. Follow these guidelines if resuscitation is necessary.
(a) All trauma patients should receive supplemental oxygen through
the appropriate delivery device and at the correct concentration.
(b) Establish a minimum of two large-caliber IVs (#16 gauge or larger).
(c) When you have established that a patient is in a shock-like state,
apply MAST, if appropriate.
(d) Carefully monitor all trauma patients with an electrocardiogram.
(e) Consider placing urinary and nasogastric catheters.
When you discover the patient needs life-saving measures, begin the
measures at once. Start airway maintenance, cardiopulmonary resuscitation,
or any other life-saving measure you think necessary. DO NOT wait until you
have completed the primary survey to begin life- saving measures.
f. Secondary Survey: General. The secondary survey follows the primary
survey. In the primary survey, life-threatening conditions have been identified and
treated. Now, you may begin a more thorough examination of the patient. If the patient
has any fractures, you will splint them during the secondary survey. Now, start the
secondary survey by checking the patient's vital signs and evaluating his airway. Then,
begin a head to toe examination, following this procedure: