Polytrauma Assessment : Mnemonics

Adjuncts to Primary Survey

PEA COVER

1. Pulse oximetry
2. EtCO2
3. ABG
4. Catheter (NG tube and Urethral)
5. Output (urinary)
6. Vital signs
7. ECG
8. Radiographs (Chest Xray and Pelvic X-ray)

Primary Survey

ABCDE

1. Airway and C-spine protection
2. Breathing
3. Circulation and control of hemorrhage
4. Disability (neurological status)
5. Exposure and Environment

Secondary Survey History

AMPLE

1. Allergies
2. Medications
3. Past illness
4. Last meal
5. Events surrounding the injury

Consciousness level assessment (Disability)

AVPU

1. Alert
2. Verbal stimuli
3. Pain stimuli
4. Unresponsive

Life threatening chest injuries to rule out in Breathing Assessment (Primary survey)

ATOM-FC

1. Airway obstruction or disruption
2. Tension pneumothorax
3. Open pneumothorax (sucking chest wound)
4. Massive hemothorax
5. Flail chest
6. Cardiac tamponade

Potentially life threatening chest injuries (Secondary survey)

ATOM-FC

1. Aortic injury
2. Thorax injuries (non-massive hemothorax, simple pneumothorax)
3. Oesophageal perforation
4. Muscular diaphragmatic injury
5. Fistula (bronchopleural) and other tracheobronchial injury
6. Contusion to the heart or lungs

Massive hemothorax

Rule of “3”

Massive hemothorax is defined by the need for thoracotomy guided by volume drained after thoracostomy –

1. Initial drainage > 1/3rd of blood volume (>1,500 ml)
2. Drainage >3 ml/kg/hr of blood volume over 3 consecutive hours (>200 ml/hr for 3 consecutive hours)

ATLS 80/70/60 rule for palpable blood pressure

NEXUS criteria and Canadian C-spine rule for C-spine clearance

Indications of CT head in Minor Head injury (Canadian CT Head Rule)

VAGABOND

1. Vomiting >2 times
2. Amnesia before impact >30 minutes
3. GCS <15 for >2 hours
4. Age >65 years
5. Basal skull fracture
6. Open skull fracture
7. Dangerous mechanism

Hemorrhagic Shock Stages

Think of the scores in a game of tennis: Love – 15 – 30 – 40 — game over (>40)

1. Stage 1: <15% blood loss (<750 ml, considering adult blood volume of 5 L)
2. Stage 2: 15-30% blood loss (750-1500 ml)
3. Stage 3: 30-40% blood loss (1500-2000 ml)
4. Stage 4: >40% blood loss (>2000 ml)

Fat Embolism Syndrome – Gurd’s criteria

CPR RFT FAT EJR

A. Major criteria: CPR

1. Cerebral involvement
2. Petechial rashes
3. Respiratory insufficiency

B. Minor criteria: RFT FAT EJR

1. Retinal involvement
2. Fever
3. Tachycardia
4. Fat macroglobulinemia
5. Anemia
6. Thrombocytopenia
7. ESR increased
8. Jaundice
9. Renal signs

Definitive diagnosis = 1 Major + 4 Minor criteria

Damage Control Orthopedics (DCO) – Indications

ABCDEFGH

a. Acidosis: base deficit >/= 8

b. Blood transfusion: >10 Units of packed cells

c. Cold temperature: <35 c

d. Damage: ABC

• Abdominal and/or pelvic trauma with hemorrhagic shock
• Bilateral lung contusions
• Chest trauma with ISS >20 or ISS >40 without Chest trauma

e. Extremis (ongoing uncontrolled blood loss despite resuscitation) or Unstable (hemodynamically unstable despite initial intervention)

f. Femoral fractures: Bilateral

g. Geriatric patients: >65 years

h. Hours: >90 minutes operative time

Dr. Sulabh Kumar Shrestha, PGY2 Orthopedics

He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.