Resident Readiness General Surgery by Debra Klamen, Brian George, Alden Harken, Debra Darosa

any lifesaving procedures
• Determines the patient’s disposition (ie, additional imaging, OR, ICU)
• Discusses the patient’s status with the family members
Airway specialist (2 people—anesthesiologist, ED attending, or senior residents of either specialty with 1 person serving as an assistant):
• Controls the airway, ensuring patency
• Performs any airway interventions, excluding the performance of a surgical airway
• Maintains cervical spine stabilization
Primary surveyor (surgical resident):
• Performs the primary survey, relaying all pertinent findings to the team
• May perform the secondary survey, relaying all pertinent findings to the team
• Performs or assists in the performance of any lifesaving procedures at the direction of the team leader
Secondary surveyor (surgical resident or intern—this is you!):
• Assists with the “exposure” aspect of the primary survey (see below) and applies warm blankets
• May perform the secondary survey, relaying all pertinent findings to the team
• Performs or assists in the performance of any lifesaving procedures at the direction of the team leader
ED nurses (usually 2, with 1 person performing procedures and 1 serving as a recorder):
ED nurse #1 (procedural). Obtains vital signs:
• Establishes peripheral intravenous (IV) access for the administration of drugs, fluids, or blood products
• Inserts indwelling devices (ie, nasogastric or orogastric tubes and urinary catheters) at the direction of the team leader
ED nurse #2 (scribe). Records all vital and physical exam findings obtained from the primary survey:
• Lists in chronological order any interventions performed on the patient
Note that, as a new intern, you should position yourself next to the patient, most likely next to the primary surveyor or on the patient’s left. You should expect to aid with removing clothing and getting warm blankets. You may also be called on to perform all or part of the secondary survey, perform the FAST exam, or generally be another set of hands. As you become more experienced, you may be able to move into the role of primary surveyor, especially for those trauma activations that are less acute.
3. The goal of the trauma primary survey is to identify and immediately treat any life-threatening injuries. This is in contrast to the secondary survey, the purpose of which is to ensure that no other major injuries were missed and to identify any additional, non–life-threatening injuries.
The primary survey is best accomplished in a team-oriented, standardized fashion in order to ensure the best possible outcome for the patient. The mnemonic ABCDE ( A irway, B reathing, C irculation, D isability, and E xposure/ E nvironment) is useful in helping one remember the order in which the primarysurvey should be carried out. Note that these steps should be repeated any time there is a change in the patient’s status.
The first priority should always be the a irway, with the assessment focused on determining if the patient’s airway is patent or not and, if so, determining whether or not the patient can maintain an intact airway. This can be initially assessed by simply asking the patient a question such as “What is your name?” If the patient is able to speak in a clear voice, the airway is intact. However, if there is no response, speech is garbled, or it takes considerable effort to speak, intervention is required. This may simply consist of a chin lift, jaw thrust maneuver to open up the airway, suctioning if the airway is occluded by blood or vomitus, or removal of any foreign bodies. In some cases, however, placement of an endotracheal tube (ETT) is indicated. If orotracheal or nasotracheal intubation is not possible, then a surgical airway (ie, cricothyroidotomy) may be necessary. During the airway assessment, inline stabilization of the cervical spine should be maintained until a cervical injury has been ruled out.
Next, the patient’s breathing or the ability to