Primary assessment of the trauma patient

The chart that follows outlines the parameters for assessing the trauma patient along with their
associated assessment
steps and appropriate interventions.
Parameter Assessment Interventions
A Airway • Airway patency • Institute cervical spine immobilization until X-rays determine
whether the patient has a cervical spine injury.
• Position the patient.
• To open the airway, make sure that the neck is midline and
stabilized; next, perform the jaw-thrust maneuver.
B Breathing • Respirations (rate, depth,
effort)
• Breath sounds
• Chest wall movement and
chest injury
• Position of trachea (midline or deviation)
• Administer 100% oxygen with a bag valve mask.
• Use airway adjuncts, such as an oropharyngeal or a nasopharyngeal airway, an endotracheal tube, an
esophageal–tracheal
combitube, or cricothyrotomy, as indicated.
• Suction the patient as needed.
• Remove foreign bodies that may obstruct breathing.
• Treat life-threatening conditions, such as pneumothorax or
tension pneumothorax.
C Circulation • Pulse and blood pressure
• Bleeding or hemorrhage
• Capillary refill and color of
skin and mucous membranes
• Cardiac rhythm
• Start cardiopulmonary resuscitation, medications, and defibrillation or synchronized cardioversion.
• Control hemorrhaging with direct pressure or pneumatic devices.
• Establish intravenous (IV) access and fluid therapy (isotonic
fluids and blood).
• Treat life-threatening conditions such as cardiac tamponade.
D Disability • Neurologic assessment, including level of
consciousness, pupils, and
motor and sensory function
• Institute cervical spine immobilization until X-rays confirm the
absence of cervical spine injury.
E Exposure
and environment
• Expose for injuries and
maintain a warm environment once exposed.
• Examine the patient to determine the extent of injuries.
• Provide warm blankets, warmed fluids, or use overhead
warmer. If an environmental exposure is determined, the use of
institute-appropriate therapy (warming therapy for hypothermia
or cooling therapy for hyperthermia) may be indicated