19/12/2023
XABCDE approach to trauma.
1. First, identify EXSANGUINATING hemorrhage. Apply a tourniquet to injuries that will benefit from a tourniquet or use combat gauze for other sites.
2. AIRWAY management is difficult in the tactical environment. Traditional airway management techniques are used but are often difficult because of low light, lack of traditional airway supplies, and lack of additional providers. A rescue airway, such as the King LT or the CombiTube, may be the best option for an advanced airway in a tactical situation. A surgical airway may be required if the patient has a clenched jaw, airway obstruction, cervical spine injury, or severe maxillofacial trauma and the airway can not be maintained by sitting the patient up.
3. Assess BREATHING for conditions that may affect oxygenation and ventilation. For large chest wounds, apply a chest seal or occlusive dressing with close observation to avoid "sucking" chest wounds. Tension pneumothorax should be identified quickly and needle decompressed.
4. CIRCULATION should be supported with fluid administration. However, those with penetrating torso injuries should be allowed permissive hypotension. Peripheral 18 g IVs are acceptable for resuscitation, and an IO may be placed, if unable to obtain PIV access. When no pulse is found, CPR is not utilized in an unsecured area and has minimal use even in a secured area, as is not effective in a traumatic arrest.
5. To assess DISABILITY, the neurologic status should be evaluated as soon as possible. The pupillary response should be noted. Mental status should be assessed. GCS can be used but may be difficult in a tactical situation. The AVPU (Awake Verbal Pain Unresponsive) assessment may be more helpful.
6. When able, EXPOSURE of the patient should be performed to allow full evaluation. Be careful to prevent hypothermia.
Photo credits to google.
