o. Secondary Survey: Neurological Status. Check the patient's level of
Perform definitive care of each injury during this survey.
p. Secondary Survey: Patient History. Obtain the patient's history using the
word AMPLE to help you remember the information to ask for. AMPLE stands for the
A--Allergies. Does the patient have any allergies?
P--Past illnesses. What illnesses has the patient had?
L--Last meal. What foods (solids and liquids) did the
patient consume last?
E--Events preceding injury. What was happening just
before the patient was injured? (This
question should bring about a reply
that tells you how the injury occurred.)
VENOUS CUT-DOWN PROCEDURE
Several conditions indicate a need for venous cut-down. Use the procedure
when it is impossible or hazardous to locate a vein large enough for a needle to pierce
unbroken skin; for example, when normally accessible veins are collapsed because of
volume depletion or peripheral vasoconstriction. Other conditions are when the patient
is obese or very young and when large quantities of fluid must be given rapidly; for
example, in a trauma patient.
a. Anatomical Considerations. There are two good sites for a venous cut-
down procedure: the primary site and the secondary site.
(1) Primary site. The primary site is the greater saphenous vein at the
ankle. This vein is located at a point approximately two centimeters anterior and medial
from the medial malleus.
(2) Secondary site. A secondary site is the antecubital median basilic vein.
This vein is located two and a half centimeters lateral to the medial epicondyle of the
humerus of the flexion crease of the elbow.