INITIAL ASSESSMENT:
Airway and C-Spine:

• Secure airway, Endotrachael tube or NT; check for bilateral breath sounds and no epigastric sounds; check placement -CXR

Breathing:

• Administer O2;check pulse Ox, ABGs; check for breath sounds, trachea position, chest wall trauma; check for deviated trachea-if present insert needle and relieve tension pneumothorax-chest tube. Sucking chest wound(apply dressing as patient exhales)

Circulation:

• Assess vital signs, start IV line with Normal Saline unless otherwise indicated. ECG, monitor urine output, check pulses, checkheart sounds and for JVD, rule out cardiac tamponade

Disability:

• check level of consciousness: alert, responsive to vocal stimulation, painful stimulation, unresponsive. Pupils equal and reactive, Glasgow scale

Exposure:

• maintain stable spine, undress, complete visual exam

Resuscitation:

• Oxygen, monitor,start IV's.
• Blood type and cross:
  • Shock: 2 units, plus 2 units for every 40mmHg decrease in systolic blood pressure.
  • Decreased Hct(<30): 2 units for each liter of anticipated blood loss).
• LAB: ABG, CBC, SMAC.

Secondary Survey:

• "Fingers or Tubes in every opening" only after stabilizing threatening problems. Exam from head to toe, paying attention to pupils, fundi, reflexes, and level of consciousness.

MEDICAL EMERGENCIES:
Anaphylaxis:

• Mild:Epinephrine
  • 0.3-0.5mg
    (0.3-0.5ml of 1:1.000 sol)
    SQ-Peds:0.01 mg/kg,
• if upper airway edema is occurring, early intubation should be performed. Oxygen.
  Volume infusion and pressor support may be necessary. Consider
  • Albuterol
    • 0.5% HHN
    • 0.3-0.5ml in 2.5 ml NS for bronchospasms
  • Benadryl
    • 50-100 mg IM.
  • Methylprednesolone
    • 50-100 mg IV.