Trauma Management for the USMLE Step 2 CK exam

by / Friday, 11 June 2010 / Published in Surgery


Trauma patients are managed using the ABCDE’s in the primary survey after a traumatic incident.

A – Airway

  • Ensure patient is immobilized and maintain airway with jaw thrust
  • If airway cannot be established, insert 2 large bore needles into the cricothyroid membrane
  • Never perform tracheotomy in the field
  • If patient is unconscious or you cannot establish an airway otherwise, intubate the patient.

B – Breathing

  • Look for chest movement
  • Listen for breathing sounds
  • Observe the respiratory rate
  • Look for life-threatening injuries (tension pneumothorax, flail chest, open pneumotorax)

C – Circulation

  • Placement of 2 large-bore IV’s in the upper extremities
  • If patient is in shock, place a central line in the patient
  • Keep blood on stand-by in case of hemorrhage

D – Disability

  • Assess the neurological status with the Glasgow coma scale
  • Check all lab tests (blood, ETOH, electrolytes)
  • Loss of consciousness

A loss of consciousness can be assessed with the mnemonic AEIOU TIPS

Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychogenic, Stroke

E – Exposure

  • Examine the skin (must remove all clothes)

 

In the secondary survey, perform the following:

  • Check the Glasgow coma scale
  • Check all orifices for trauma and/or injuries (bleeding)
  • Perform checks using ultrasound, XRAY, CT
  • Check for compartment syndrome

 

GLASGOW COMA SCALE

STATUS/FINDING POINTS
Eye Opening  
Spontaneous 4
To Voice 3
To Stimulation 2
No Response 1
Verbal Response  
Oriented 5
Confused 4
Incoherent 3
Incomprehensible 2
No Response 1
Motor Response  
To Command 6
Localizes 5
Withdraws 4
Abnormal Flexion 3
Extension 2
No Response 1
     

A coma scale below 8 indicates severe neurologic injury

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