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Tertiary Trauma Assessment Overview

The tertiary trauma assessment is a comprehensive re-examination of the trauma patient performed within 24 hours of admission to further evaluate for injuries that may have been missed during the initial assessment and resuscitation in the emergency department. It involves repeating the primary and secondary trauma surveys, which systematically assess the airway, breathing, circulation, disability and environment, as well as a full head-to-toe examination. The tertiary assessment helps reduce the risk of missed injuries and ensures all injuries are appropriately diagnosed and managed for optimal patient outcomes. It should be performed on every trauma patient in a consistent manner.

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Angelie Pantajo
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48 views14 pages

Tertiary Trauma Assessment Overview

The tertiary trauma assessment is a comprehensive re-examination of the trauma patient performed within 24 hours of admission to further evaluate for injuries that may have been missed during the initial assessment and resuscitation in the emergency department. It involves repeating the primary and secondary trauma surveys, which systematically assess the airway, breathing, circulation, disability and environment, as well as a full head-to-toe examination. The tertiary assessment helps reduce the risk of missed injuries and ensures all injuries are appropriately diagnosed and managed for optimal patient outcomes. It should be performed on every trauma patient in a consistent manner.

Uploaded by

Angelie Pantajo
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Trauma Assessment

1. Save LIFE
2. Prevent major disability
3. Diagnose and appropriately
manage all injuries
4. Avoid unnecessary investigations
or interventions
Tertiary Assessment in Trauma
The Tertiary Survey
• The tertiary survey by Trauma Nurses is both
reliable and accurate
• The concept of the tertiary survey was
introduced in 1990 by Enderson and team
• The patient cohort were re-examined after
stabilization to confirm initial diagnosis and to
ascertain any delayed diagnoses
The Tertiary Survey
• The current approach to trauma management
is based on the Advanced Trauma Life Support
(ATLS) principles
• Primary survey
Secondary survey
Goal: Learn about Tertiary Assessment in Trauma

• What is the importance of the Tertiary Trauma


Assessment?
• What is new with the Primary and Secondary
Assessments?
• Every patient, every time, the same? Why is
this important?
• It’s as easy as ABC
Primary and Secondary Assessments?

• Trauma Assessment
An approach that identifies and treats or stabilizes
life threatening injuries in an efficient manner
• While done in the emergency setting, the ideals and
process can be repeated at any time, anywhere
• What are the primary and secondary assessments?
– Primary: ABCDE with resuscitation adjuncts (FG)
Secondary: H and I with reevaluation adjuncts
Primary Assessment in Trauma
• Airway and Alertness with simultaneous cervical spine stabilization

• Breathing:

• Circulation:

• Disability:

• Environment:

• Get a Full set of vital signs and Family presence

• Get resuscitation adjuncts: labs, ECG monitor, Naso-Orogastric tube, Oxygen, Pain
assessment and management
Secondary Assessment in Trauma

• Get a History and do a complete Head to Toe


Exam, looking, listening and feeling the entire
body for injuries
• Inspect posterior surface (log-roll)
What is the Tertiary Assessment?
• Usually about 24 hours after admission, the
team(MD or Advanced Practice Provider) will
perform the primary and secondary
assessment again, as well as a detailed head
to toe assessment of the trauma patient
• This aides to decrease possible missed injuries
from the initial resuscitation. Each body part is
assessed and palpated
Tertiary Assessment: importance
• “Missed injuries occur in the time-critical and
complex assessment of the severely injured
trauma patients in the Emergency Department”
• “The trauma tertiary survey (assessment) is the
proposed solution”

(2012) Keijers et al. The effect of tertiary surveys on missed injuries in


trauma: a systematic review J Trauma, Resuscitation & Emergency
Medicine 20:77
Tertiary Assessment
• Repeating the Primary & Secondary Assessment: all bony
prominences are assessed and palpated
• It is a comprehensive general physical re-examination &
review of all investigations (labs, images) within 24 hours
of admission and is repeated when the patient is
conscious, cooperative and mobilized.
• In addition, the mechanism of injury and predicted
patterns of injury should be evaluated

2011. Collins et al. Advanced Practitioner Comprehensive Tertiary Survey


including incidental findings. J of Trauma Nursing 18, 2, 73-78
Tertiary Assessment
• After this assessment, if indicated, the patient
is sent for further radiology exams to
investigate for further injury
• Every trauma patient, after admission, needs a
Tertiary Assessment by a provider, usually
within 24 hours after admit from the ED to the
admitting floor
Tertiary Assessment
• The Tertiary assessment includes repeating
this complete head to toe exam looking for
new injuries
• If your patient mentions a new area of pain,
for instance, please alert the MD team on
rounds the morning after admission
Every patient, every time, the same
• Using this systematic approach for every
patient every time improves patient care,
patient safety and patient health
• Regardless of the initial mechanism of injury,
this triad approach (primary, secondary, tertiary
assessment) is needed within the first 24 hours
and thereafter
• With this approach, injuries aren’t missed and
patients do better

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