Use a systematic approach based on ABCDE6 to assess and treat an acutely injured patient. The goal is to manage any life-threatening conditions and identify any emergent concerns, especially in a neurotrauma patient who may present with other multisystem injuries.
Attempt to elicit a response from the patient.
Look for signs of airway obstruction (use of accessory muscles, paradoxical chest movements, see-saw respirations).
Listen for any upper-airway noises, breath sounds. Are they absent, diminished or noisy? Noisy ventilations indicate a partial airway obstruction by either the tongue or foreign material.
Haemorrhage, vomiting and swelling from facial trauma are common causes of airway obstruction in patients with TBI. These should be removed with suction.
Assessing for adequate ventilatory effort is essential in the early stages of TBI.
Administer oxygen to achieve oxygen saturations between 94-98%.
Ensure that any alterations in the patient’s level of consciousness are not related to a metabolic cause.
Remove all clothing from the patient and assess to ensure there are no other obvious, life-threatening injuries present.
Keep the patient normothermic through passive re-warming with blankets and a warm environment.