1. Primary Survey (ABCDE Approach)
- Airway with Cervical Spine Protection: Assess for patency, foreign bodies, or trauma. Intervene with jaw thrust, suction, or advanced airway management if necessary. Consider cervical spine immobilization in cases of trauma.
- Breathing and Ventilation: Look for chest rise, listen for breath sounds, and feel for air exchange. Assess for pneumothorax, hemothorax, or flail chest. Provide supplemental oxygen or ventilation support as required.
- Circulation with Hemorrhage Control: Check pulse, blood pressure, and capillary refill. Identify and control major bleeding. Administer fluids or blood products for signs of shock.
- Disability (Neurological Status): Evaluate consciousness using Glasgow Coma Scale. Check pupil size and reaction for signs of brain injury.
- Exposure/Environment Control: Fully expose the patient to identify all injuries while preventing hypothermia. Maintain a warm environment.
2. Secondary Survey
- Conduct a thorough, head-to-toe examination, assessing all body areas for injuries.
- Collect detailed medical history, focusing on the mechanism of injury and pre-existing conditions.
- Implement diagnostic tests, including laboratory investigations like complete blood count, coagulation profile, blood typing, and serum chemistries.
- Utilize imaging studies such as X-rays, CT scans, or ultrasound to identify internal injuries.
- Assess coagulation status using thromboelastography (TEG) or rotational thromboelastometry (ROTEM), particularly in cases with suspected coagulopathy.
The inclusion of TEG/ROTEM in the diagnostic approach offers real-time insights into the patient’s coagulation status, guiding targeted interventions in managing trauma-induced coagulopathy. These tools are particularly valuable in understanding the complete picture of a trauma patient’s coagulation pathway, enabling timely and precise correction of coagulation disorders.
Thromboelastography (TEG) Values
- R-Time (Reaction Time): Reflects clot initiation. Prolongation indicates coagulation factor deficiency or anticoagulant effect.
- K-Time: Measures time until a certain clot firmness is reached. Prolongation suggests hypofibrinogenemia or thrombocytopenia.
- Angle: Represents rate of clot formation. A decreased angle indicates weaker clot strength, often due to low fibrinogen levels.
- MA (Maximum Amplitude): Measures clot strength. Decreased MA indicates weak clot strength, often seen with thrombocytopenia or platelet dysfunction.
- LY30 (Lysis at 30 Minutes): Percentage of clot breakdown at 30 minutes. An increase indicates hyperfibrinolysis.
These values offer crucial information on coagulation status and help in tailoring specific interventions in trauma management.
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a clinical tool used to assess the level of consciousness and neurological functioning of a patient who has suffered head trauma or any neurological compromise. It comprises three parameters: Eye Opening, Verbal Response, and Motor Response. Each parameter is scored individually, and the total score ranges from 3 (deep unconsciousness) to 15 (fully awake). The GCS is valuable in trauma resuscitation for initial assessment and monitoring the progression or improvement of a patient’s neurological status.
Eye Opening (E) | Verbal Response (V) | Motor Response (M) |
4: Spontaneous | 5: Oriented | 6: Obeys commands |
3: To speech | 4: Confused | 5: Localizes pain |
2: To pain | 3: Inappropriate words | 4: Withdraws to pain |
1: None | 2: Incomprehensible sounds | 3: Flexion to pain (decorticate) |
1: None | 2: Extension to pain (decerebrate) | |
1: None |
This scale helps guide clinical decisions in the management of trauma patients, particularly in determining the severity of head injuries and guiding further diagnostic and therapeutic interventions.