As we have recently been reminded during a series of natural disasters in the United States, health care providers have the extraordinary opportunity to intervene and save the lives of injured family, friends, neighbors, and strangers. To that end, this blog post will provide a review of the primary trauma survey’s ABC’s in the hopes that more physicians and providers will be able to confidently and successfully apply their skills and training during exceptionally difficult circumstances.
This case study describes circumstances similar to the ones health care providers in Houston encountered, where non-emergency room personnel were needed to assist in the ER during the hurricane and the subsequent flooding. Although the ABC’s of trauma may also be used outside the ER, few health care providers have the required equipment at home.
Case Study: You are on-call in the hospital during a hurricane when a colleague who works in the ER asks you for staffing help in managing a series of traumas that have just arrived to the hospital. You rush into a trauma bay, where first responders delivering a patient tell you that bystanders saw a vehicle careen off the road and hit a nearby embankment. The driver fell out of the vehicle and initially appeared unconscious. The person on the gurney is the driver. Do you remember the steps you learned for how to resuscitate an injured patient who may have sustained trauma?
Let’s review the ABC’s:
A: Airway. Is the patient’s airway open? On closer examination, the patient is conscious. A patient with a severe head injury or a Glasgow Coma Scale (GCS) score less than 8 would require you to place a definitive airway. However, this patient can communicate verbally, which makes an obstructed airway significantly less likely. Nevertheless, check to see if there is anything in the patient’s mouth or throat that may be obstructing the airway. Your nurse can assist you in keeping the injured patient’s cervical spine still in case there are additional spinal injuries that may be exacerbated by your interventions.
B: Breathing. Is the patient breathing? Look at the chest for symmetric chest rise and fall. Listen for any sounds of gurgling or wheezing. Using your stethoscope, you are relieved to hear bilateral breath sounds.
C: Circulation. Do you see any obvious bleeding or is the patient pale and clammy? Is the patient conscious? Can you feel a carotid, femoral, or radial pulse bilaterally? What is the patient’s heart rate?
At this point, the trauma team appears and takes over examining the patient. If you were to continue examining this patient alone, what else would you have to do?
D: Disability. Establish a baseline GCS score for the patient.
E: Exposure. Remove the patient’s clothing and examine them for additional injuries. Make sure to keep the patient warm and covered with a blanket while you perform this step of your evaluation.
Every time you find any abnormalities, you must stop and address them before continuing on to the next step. When you finish the ABC’s, start again from the beginning. Outside the hospital, your interventions will be limited by lack of equipment and staff. You may encounter complex patients, including children, pregnant women, and older adults, or you will have to start performing CPR immediately. However, if you do decide to intervene in these situations, reviewing ahead of time how to safely and effectively manage trauma patients will reward your hard work with increased confidence and competence.
Resource: American College of Surgeons Committee on Trauma. 2008. Advanced Trauma Life Support for Doctors. Chicago: American College of Surgeons.
Dr. V. Silverstein
Published on 9/27/17