Adjuncts

Adjuncts to the Primary Survey

 

1. Continuous Cardiac Monitoring / Electrocardiogram (ECG)

• Cardiac Contusion: Suspect in patients with chest trauma; ECG changes may include arrhythmias or conduction abnormalities.
• Identify Ischemia: ECG can detect signs of myocardial ischemia or infarction, which may occur due to blunt chest trauma or pre-existing cardiac conditions.
• Electrolyte Imbalances: Trauma patients may develop electrolyte disturbances affecting cardiac function.

 

2. Pulse Oximetry

• Target SpO2: 94-98%

 

3. Arterial Blood Gas (ABG) and Lactate

• Assess ventilation and oxygenation
• Identify acid-base imbalances
• Lactate measurement

 

4. Hemoglobin (Hb) Level

In Event of Acute Blood Loss:

• Hb levels may initially appear normal due to hemoconcentration.
• Serial measurements are essential.

 

5. Urinary Catheterization and Urine Output Monitoring

• Monitor renal perfusion
• Assess fluid balance

Contraindications: Urethral Injury

 

Signs of Urethral Injury:

    i. Blood at Urethral Meatus:

• Visible bleeding suggests urethral trauma.

    ii. Perineal Ecchymosis (Bruising):

• Indicates pelvic trauma with potential urethral involvement.

    iii. High-Riding or Non-Palpable Prostate:

• On digital rectal examination, a displaced prostate suggests urethral disruption.

 

Alternative Measures:

• Suprapubic Catheterization

 

6. Nasogastric Tube Insertion

Purposes:

i. Gastric decompression.

ii. Assess gastrointestinal bleeding.

iii. Minimizes the risk of aspiration.

 

Contraindications:

• Basilar Skull Fracture (signs):
  • Raccoon eyes (periorbital ecchymosis)
  • Battle's sign (mastoid ecchymosis)
  • Cerebrospinal fluid (CSF) rhinorrhea or otorrhea.
• Facial Fractures:
  • Midface fractures (Le Fort fractures)
    • Increase the risk of intracranial tube placement.

 

Alternative Measures:

Orogastric Tube

 

7. Chest X-Ray and Pelvic X-Ray

Chest X-Ray:

• Identify thoracic injuries
• Verify tube placements

 

Pelvic X-Ray:

• Detect pelvic fractures
• Assess for foreign bodies

 

8. Extended Focused Assessment with Sonography in Trauma (eFAST)

Assessment Areas:

i. Pericardial Space:

Identify pericardial effusion indicating cardiac tamponade.

ii. Peritoneal Cavity:

Detect free intra-abdominal fluid suggestive of bleeding.

iii. Pleural Spaces:

Identify pneumothorax and hemothorax.

iv. Lung Sliding:

Absence may indicate pneumothorax.

 

Advantages:

Speed: Can be performed rapidly at the bedside during resuscitation.

Repeatability: Allows for serial examinations to monitor changes.

Safety: No radiation exposure.

 

Limitations:

i. Operator Dependency

ii. Limited Views

• Injuries outside these regions, such as retroperitoneal or diaphragmatic injuries, may be missed.

iii. Limited Sensitivity for Certain Injuries:

• Small amounts of free fluid and injuries to the hollow organs may be missed

iv. Obesity and Subcutaneous Air.

v. Cannot Differentiate Fluid Types:

• eFAST identifies free fluid but cannot differentiate between blood, urine, or other types of fluid.