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Okay, so and we'll tell me about your primary survey in trauma. And so when I guess part of us is on, from my perspective, is a senior. As with the condition, I tend to get any bad with an overview of what's going on. Um, but we're aware that and the majority of rules are icy. Hands on. You will be responsible for a small part of this is primary survey. So they will take us through in your view of what? What the primary survey eyes up together on. But you appreciate, once we get into some scarring, widely it wrong that you will be having a rule, a rule to play. And it may just be one or two of the slaves we go through that you'll be actually involved with. Um, this guy is the sculpture this off ago or more? Um, he's called my mom like clear part, and for this on one of his things was a clock on disability, which is sometimes when we get a major trauma, that's that's only 13 has to be invisible. And so hopefully this time will give that we've ever structure just a week or three and I remind a major trauma cation. Okay, so you're gonna get hopefully a warning with patients, right? No ways. But normally today. And so at that point, you want to get rather he want to do a pre brief. I like it rules. So for us, that means, But I made trouble go, which would get you the surgical team on your 80 consultant. And if you need on the Celexa needed for them separately because they aren't currently on our trauma co. What's team arrives That he won't. Uh um just shells Explain what's happening. Related information we know already from the prehospital. Uh, stand by and then allocate your team rules. A. So he used to, uh it's important that we just are aware that we put people into rules that are coming to do. Next thing, as the as the paramedics are willing, the patient and teres us, we'll Teo check. And Okay, so for me, that's ah, very quick. As the patients about pulse. Are there any interventions required immediately or are we okay to take a two minute honzo hum over? Okay, place. Patient has going to cardiac arrest or if they are pararescue then we might just get the patient street over onto Are troll Matters on and yeah, our team to start Assassin the patient while apartment extend come into the team leader and describe I'm giving her on over at that point. But if the patient has being stable ish and the ambulance and doesn't need anything immediately done and then we can there's whole 30 minutes we have sighted. It's in the in the bay on everyone listens to the par Matics you're getting over the hump you were. Hopefully, they will give us, um, not less Tom Mover following. I mean amounts. That's well, you recognize out from our sound by forms because that stuff on but it's based on so age patient. Have no name, have known a time of injury mechanism of injury. Um, I use for injuries and asks for signs. Thing as part should really follow up on a B, C, D or ahead to sometimes get had the tools or less stuff off signs. Uh, finally tease for treatment was given already important that we try and just jot doing what times those medications have been given. So it's always the classic departments of laughed. We want to do one time to the base. And how about morphine? Oh, so and try and get there was been advanced. Of what time it was going up. Okay, so the very first thing we'll do is, um see, So no, I didn't see. And trauma C is for catastrophic external average. Okay? And that's really for everyone to have a quick blunts. Um, I will not quit Glance about proper look on the patient. One of them looking for any external catastrophic hemorrhage. Socially important, like we said in there. And the video for the local that with you, when you take the patient off the vacuum mattress that personally pills the Mavericks are you tried any of the patients looks at it to make sure that there's no you have to blow up there. So what we do if we see some catastrophic actually hemorrhage? Well, we try and stop it so you can apply direct pressure. We've got a range of him, a salad dressings and or recess play and which you can apply on. It might be able to elevate it a lot. You know, um, you know, apply tourniquet. You think it's um, arterial and I mean classic. One that we can see is a scout wind. Scotland's complete so much a sculpted that's just holding bloods them off needs it. And, uh, a few situations to try and stop the bleeding. Uh, so why I get ready to do that? You you always Ricardo both rest of here of your primary surgery, but important that we didn't stop. Also, at this point, there's no already been given prehospital e we would need to give ground off, examine acids china to get 50 mg per kilo. Then we were able to areas as well. See Spain control on. So look at the airway one So is apparent on. We obviously want to avoid the have told shutting off the salt on gas it this morning, and but the required or thrust to keep her there Every patient the same time. We're thinking about the C spine so and we tend to start off with model and line stabilization. Uh, most of these basically come in by ambulance will already have color and please. So we just want to make sure that it's well fitting correctly if the airway is okay. Um, you got the color old. Uh, the person who's up the airway is assassin A and probably about points to start taken what we call, um hum bull history. I was just like we need more, like just remind us off the pertinent things that I ask. So we want to ask about allergies, about any routine medications, any past medical history, when the last thing to eat or drink the events surrounding the injury. That's just a quite quite a nice way just for the personal opinion. Ta get some pertinent details while the rest of the time it's really is going on. Then we're gonna be able to be. So we start being by assess and key. And first of all, make sure that central I am. We look at the chest itself on before it doesn't go through each of these sections of each person rule. One of the main things you need to be doing is getting doing the skin so and I often try and allocate a member of the team to cut clothes off on. Sometimes it takes a couple at the time that will the patients where it and we had to see that chest isn't in deformity. A Xeni bruising Erin or anyone's was in a crappy this, which might represent some surgery on the scene from him on both Rx have a look at the movement of the chest wall is a beautiful thing as symmetrically on Well, on then, Finally, one place clowns on, um, is realizing normal size with percussion and auscultation auscultation calm enough. It will recover that again, but it can be hard to hear a rain, Always the results. So another reason for us to try and keep out Now he's doing okay, But you're you're getting more by the bills are things, you know. It was chest moving. Can we see it moving? And so in some ways were helpful. And then we also want to think about over our normal Ultravate Shin soo, and it's proven the finger. And for the respiratory and pretty that's properly on for a full minute. No, the hands or cause you might not be able to get your saturation is over there. Well, so you may need to think about it. A. Sounds probably a year now they're going to want to see, And so that's time. I mean, It was kind of horrible examination, not see and compared to your medical patients on, So we're gonna feel the hands or the warm in the schools, Have a pulse, make sure we've got decent IV access. And on day, if we can get blood off, we we want to get Bloods primarily for across much, but also for for blood. Usually he's in a quiet relations screen room attack of the BG on the bone profile as well. And will it for BP? We come up towards the night. We think about other distended night visions. The final. I always take a listen to the heart itself, Applying some wondering, I got three made a C G 12 with the CT. Later on, it's the old saying is a part of See, we were for sites of bleeding or places where where the patient might be bleeding into you and the old saying is on the floor on four more so floor just up in pelvis, long bones, or the five areas that patients who will bleed comma structurally into Okay, so it's never a A. It's on the floor. Then you will find out with the plan direct pressure and him aside dressings situation if you need to, um, consider a tourniquet on all about seven in the building drawing resource. We look at the chest, Um, it's a massive him a thorax. Then when you think about 10 of progesterone and but you you would need that chest until you have blood rubbing on through the candles, abdomen and needs to go see it or not one drink a day. But after that, you pretty into there, Elvis on your belly. If you've got an open palette fracture, you got a sort of open, open and speediest on what you could bleed. So the public buying their will pull pull this together for you and her. Just stop playing golf right on the long bones Them, I said those lose mainly the femurs really were thinking about it. But you can bleed a lot of the femurs, um, that compartment. So the application of either candidate or Thomas splint well helped us ever Just stop with well, the day, uh, have a look at people's. We're only takes that we add like aged for for assessment of those old, and that works for trouble as well So is for out pretty or GCS genes for glucose is for the eyes on these for drugs or toxins. Yeah, important gamble. Trigger these patients as well and we want to get care. GCS broken. Don't take an ice voice. The blood people is always a Azzam, always a worry anxiety and had a dream and tends to be on the same side as the intracranial bleed on. It's thought to be caused by direct compression of the third nerve. Uh, certainly for supratentorial way. Also, let's take a walk to the 20 last relation. Same. So the lung people is the last five saying we also want to look at 11 way, can be sometimes thrown off by that going to look and see they're not moving, for example, they're left arm. That might be because of trying to injury to the shoulder of the arm itself. Okay, it might be might be higher up if the airway it was okay, right? This is the opportunity. And for the theory person on defeat Bye about the, um palustre to the team said already and we're gonna be able takes because you're already that we want to expose this patient right going to skin on. But I think one of the funniest things I've ever seen in recess Waas I had a patient who had a feather down coat on. Um, we were happily cut it to shreds. We're finding feathers and results for weeks afterwards had thought really important and aspect of good trauma care is getting the patient strip going to skin On the other side of that coin, though, is that we must keep them warm. You must try and keep them at the pharmacy possible, so it's getting close off, which to be fair and northern and are often wet and cold and damp. So we want to get off anyway because you're not gonna get warmed up with who's cooled down. Cools on eso get close. Cut off during the skin I exposure before they examined the the abdomen and the pelvis in the long bones is part of our see assessment. But here we want to look at the extremities. We want to make sure that there's not another injury for example, a fracture dislocation of the ankle, which has Norvasc compromise because that's kind of injury that will result in a lot of mobility for these patients who? And we don't want to mess that in the primary. Serve any suit. And if they have ah, for example, a fracture dislocation of an ankle. We would want to hear adjusting that as part of our immediate management. Um, it won't make things we want to think about is what messes, which is that the triad of death of trauma is no nose, and I'm really these. These three things will freedom to really per prognosis for patients. You'll see the bottom left is hypothermia, so cool patients don't do well where you need to keep them work. Likewise, as a time was on, pace will become quite a Catholic if they're bleeding. And that would calm acidotic if we started seeing these three things in patients is really worrying to sign. Okay? And so most are a lot of what we do in terms of the coupons, um, of trauma is trying to avoid these three things from happening, especially at those first few hours that really for us, it's, ah, bad decision. And it's a shared decision, a sort of team meeting between team um on the green phlegm. If they're stable way could get the CT well, considering inoperable a CT, depending on the injury we made you for a CT. Efforts look place to one body area if they are very unstable on the rattle, and then way might think about trying to get into theater here before surgeons feeling that making on do that uh, otherwise we need to think about. Are the patients able to go to the Royal on and are major trauma center as a cold sand patient training for me? D. We'll talk about later. Okay, so that was a very quick run through off the approach to trauma the primary survey in trauma on but just to kind of refresh remains. And but we've got lots of more of talks coming up about each of those definite laments and a bit more detail.