Trauma Primary Survey Medical Slides

Present each step with critical decision points: A (Airway with C-spine protection) — talk to the patient, look for obstruction, jaw thrust not chin lift, GCS ≤8 or expanding neck hematoma = definitive airway. B (Breathing) — inspect, palpate, percuss, auscultate, identify tension pneumothorax (needle decompression before imaging), open pneumothorax, flail chest. C (Circulation) — hemorrhage control is priority, 2 large-bore IVs, FAST exam, transfuse before crystalloid. D (Disability) — GCS, pupils, lateralizing signs. E (Exposure) — logroll, prevent hypothermia. Emphasize the iterative nature — return to A if patient deteriorates.

Present the PROPPR trial (2015): 1:1:1 (plasma:platelets:RBCs) vs 1:1:2 showed no difference in 24-hour or 30-day mortality, but 1:1:1 achieved hemostasis faster and fewer exsanguination deaths at 24 hours. Include CRASH-2 trial: TXA within 3 hours of injury reduced all-cause mortality (14.5% vs 16.0%), but TXA after 3 hours increased bleeding deaths. Present MTP activation criteria (ABC score ≥2 or clinical judgment) and viscoelastic-guided resuscitation (TEG/ROTEM) for goal-directed component therapy.

Present eFAST as a bedside adjunct during C (Circulation): four standard views (subxiphoid cardiac, RUQ hepatorenal/Morison pouch, LUQ splenorenal, suprapubic) plus bilateral anterior thoracic views for pneumothorax. Sensitivity for hemoperitoneum: 73-88% (operator-dependent), specificity >95%. Key teaching points: positive FAST in unstable patient = OR for exploration (no CT); negative FAST does not exclude injury (sensitivity limited for solid organ injury <200 mL free fluid and for hollow viscus/diaphragm/retroperitoneal injuries). Serial exams improve sensitivity.