In conducting a primary survey on a trauma patient, which of the following is considered one of the priority elements of the primary survey?
A. Brief neurologic assessment
B. Client's allergy history
C. Initiation of pulse oximetry
D. Complete set of vital signs
Correct Answer: A. Brief neurologic assessment
A brief neurologic assessment to determine the level of consciousness and pupil reaction is part of the primary survey. Once the patient is stabilized, a neurologic examination should be conducted. CT scan is the diagnostic modality of choice in the initial evaluation of patients with head trauma.
Option B: Primary injury includes injury upon the initial impact that causes displacement of the brain due to direct impact, rapid acceleration-deceleration, or penetration. These injuries may cause contusions, hematomas, or axonal injuries.
Option C: Identify any condition which might compromise the airway, such as pneumothorax. The cervical spine should be maintained in-line during intubation. Nasotracheal intubation should be avoided in patients with facial trauma or basilar skull fracture.
Option D: Vital signs are considered part of the secondary survey. Avoid hypotension. Normal blood pressure may not be adequate to maintain adequate flow and CPP if ICP is elevated. Isolated head trauma usually does not cause hypotension. Look for another cause if the patient is in shock.
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