Pediatric Trauma Assessment (Primary and Secondary Survey)

Primary Survey The Primary Survey is performed to rapidly identify and manage life-threatening conditions. Priorities include: - Catastrophic Hemorrhage - Airway (with cervical spine control) - Breathing - Circulation - Disability (Neurological Status) - Exposure / Environment Control Pre-Arrival Preparation - Trauma Team Activation: The trauma team was activated based on the mechanism of injury and the patient's unstable vital signs. - Pre-Arrival Briefing: The team was briefed on the patient's condition, roles were assigned, and equipment was prepared. - Medication & Equipment Preparation: Weight-based drug doses were confirmed, and all necessary equipment was ready. - Protective Measures: Personal protective equipment and radiation protection were utilized. On Arrival - Handover: The I-MIST-AMBO handover from paramedics included the mechanism of injury, injuries sustained, signs, treatment given, allergies, medications, background, and other relevant information. - Parental Communication: Additional history was obtained from the parents, including the child's medical history and allergies. - Support for Family: Emotional support was provided to the family, and they were kept informed of the child's condition. Airway and Cervical Spine Life Threat: Airway Obstruction - Assessment: Airway was patent with no obstructions noted. No facial fractures or signs of burns were present. - Neck Examination: No tracheal deviation or other airway threats were identified. - Airway Management: The airway was maintained with positioning and suction. - Cervical Spine Management: Spinal precautions were confirmed with a cervical collar applied. Breathing Life Threats: Tension Pneumothorax, Open Pneumothorax, Massive Hemothorax, Flail Chest - Assessment: The patient exhibited increased work of breathing and decreased chest expansion on the right side. - Examination: Decreased breath sounds on the right side were noted on auscultation. - Management: Oxygen was administered, and a chest drain was inserted on the right side. Circulation Life Threat: Hemorrhagic Shock - Assessment: Heart rate was elevated, capillary refill time was prolonged, and blood pressure was low. - Sites of Bleeding: No external bleeding was noted; internal bleeding suspected in the abdomen. - Interventions: Fluid resuscitation was initiated, and blood products were prepared for transfusion. Disability (Neurological Status) Life Threat: Traumatic Brain Injury - Neurological Assessment: GCS score was 13, indicating mild head injury. - Pupillary Exam: Pupils were equal and reactive to light. - Motor Function: Limb movements were symmetrical with no deficits. - Blood Glucose: Capillary blood glucose was within normal range. - Neuroprotection Strategies: Head elevation and normothermia were maintained. Exposure and Environmental Control - Full Body Inspection: No additional life-threatening injuries were identified. - Hypothermia Prevention: Warm blankets and a warming device were used to maintain normothermia. Radiology and Imaging - Imaging Ordered: Chest X-ray and abdominal CT scan were ordered. - Findings: Chest X-ray showed right-sided pneumothorax; abdominal CT scan was pending. Secondary Survey The Secondary Survey is performed once the patient is stable, and all immediate life threats are addressed. Preparation - Communication and Reassurance: The patient was reassured, and parents were involved in the care process. - Positioning and Comfort: Pain management was provided with analgesics. Head and Face - Inspection and Palpation: No scalp lacerations or skull fractures were noted. - Eyes: No eye trauma or visual impairment was observed. - Ears and Nose: No bleeding or CSF leaks were present. - Mouth and Jaw: No oral trauma or dental injuries were found. Neck - Inspection: No neck bruising or tracheal deviation was observed. - Palpation: No vertebral tenderness was noted. Chest - Inspection and Palpation: No seat belt injuries or paradoxical movement were observed. - Auscultation: Breath sounds were decreased on the right side. Abdomen - Inspection and Palpation: No bruising or distension was noted; tenderness was present over the right upper quadrant. - Genitourinary Examination: No signs of trauma were observed. Pelvis - Inspection and Palpation: No pelvic instability or tenderness was noted. Limbs - Inspection and Palpation: No fractures or soft tissue injuries were observed. - Range of Motion: Full range of motion was present in all joints. Back - Log Roll Assessment: No tenderness or deformities were noted along the vertebral column. - Spinal Palpation: No abnormalities were detected. Urinalysis - Test Results: Urine dipstick was negative for blood. Disposition Planning - Ongoing Management: Abdominal CT scan results pending; surgical consultation requested. - Pain Management: Analgesia was administered with good patient response. - Surgical Consideration: Possible surgical intervention pending CT results. - Definitive Care Plan: Plan for ICU transfer for close monitoring. - Handover Details: The ICU team was briefed, and a formal handover was completed.