In this section
In the primary survey, circulation becomes the priority after airway and breathing have been definitively managed. Delivery ofoxygen to the tissues is dependent on adequate circulation. In this chapter, differences between adults and
children are discussed followed by a review of circulatory compromise and its definitive management.
Hypotension indicates that death is
In all aspects of trauma management,
the primary survey is the first priority
Airway with c-spine stabilisation
(see airway management section) Breathing
(see breathing management section)
Circulation assessment and management
Ensure adequate monitoring of saturations: cardiac monitor, finger on femoral pulse for pulse check.
If the pulse is abscent or less than
60 and there are no other signs of life: commence immediate chest
compressions and full cardiopulmonary resuscitation.
1. Chest compressions Infant <1 year
Ratio of compressions to breaths: 5:1
Small Child <8 years
Ratio of compressions to breaths 5:1
Landmark Two fingers above the xiphisterum Technique Two hands overlaid (as in adults) Rate 100 per minute Ratio of compressions to breaths 15:2
2. Ensure adequate vascular access
Sites of venous access
3. Obtain blood specimens for:
4. Assess and manage haemorrhage
Splint and stabilise fractures.
5. Fluid Resuscitation
Look for any signs of circulatory compromise, as above. If present consider fluid resuscitation with blood as per your own institution protocol, or as per the APLS algorithm below:
Obtain an URGENT
SURGICAL REVIEW if there has been inadequate response to the first two fluid boluses.
Reassess: HR, capillary refill, and other signs of circulatory adequacy.
If the circulatory signs are deteriorating and not
responding to fluid bolus, consider whether there is:
In hypovolaemia, fluids will need to
be infused rapidly.
6. Inotropic support
Injured patients usually require replacement of volume rather than use of inotropes. Consider discussion with a paediatric intensive care physician if you consider your patient requires inotropic support.
7. After assessment: re-assessment
Repeat Primary Survey and continue monitoring vital signs, saturation, conscious state and urine out-put.