Pediatric emergency medicine trisk 0149 0149
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of treatment. All patients with major trauma should receive supplemental oxygen
therapy. In both medically ill and traumatically injured patients, the airway is secured
via endotracheal intubation as clinically necessary. The chin-lift or jaw-thrust
maneuver is the preferred method to open the airway while clearing secretions or
preparing for intubation to minimize cervical spine movement. It is imperative to
anticipate a “difficult airway” prior to intubation. If this is anticipated, the most
experienced clinician in airway management should secure the airway. If a difficult
airway is suspected, management with bag-valve-mask ventilation or placement of a
laryngeal mask may be preferred until a definitive airway can be established in a
controlled environment.
TABLE 7.5
PRIMARY SURVEY COMPONENTS
A
Airway
Cervical spine
B
Breathing
C
Circulation
D
Disability
Dextrose
Decontamination
E
Exposure
Environment
Determine if the airway is patent
Note obstruction, complete or partial
Reposition, suction, consider artificial airways,
continuous positive pressure
Assess need for C-spine immobilization
Check for increased or poor respiratory effort
Place on continuous CR monitor, pulse oximetry,
ETCO2
Administer oxygen, assist ventilation with BVM
Consider need for ETT, have LMA ready
Decrease gastric distension
Needle thoracostomy and chest tube as indicated
Assess HR, BP, rhythm
Peripheral pulses and capillary refill, pallor,
cyanosis
Assess mental status, pupils, motor activity, and
symmetry
Cardioversion, defibrillation, pericardiocentesis
AVPU score, note lateralizing signs
Treat hypoglycemia, seizures, increased ICP
Drug overdoses, or electrolyte abnormalities
Undress patient, log roll
Check temperature, skin, and evidence of trauma
Prevent hypothermia
