Initial Assessment in Trauma

Primary and Secondary Survey

Four Important Takeaways

Have a System in Trauma

After you after made the diagnosis treatment begins with resuscitation, IV antibiotics and a decision: "To the OR, to the Floor or to the ICU"

Primary Survey

ABCDE...you know your ABCs?


The important consideration in the primary survey is that Airway, Breathing, Circulation, Disability and Exposure need to be evaluated and treated simultaneously!

Where can you bleed?

Remember the spaces one can bleed and send themselves into hemorrhagic shock.  This includes the environment, the chest, the abdomen, the pelvis, the retroperitoneum, and the soft tissues!

Set up for Success

Along with systems, set up is important. Remember to organize your team and have life saving equipment available and ready.  In this video I'll show you how I do it!

Notes from the Video

What You're Going to Learn from This Video on Treating Appendicitis


As a surgeon one of the most common operations I do every week is a laparoscopic appendectomy...removing a child's appendix.


But the treatment of appendicitis begins before you get to the operating room, it begins immediately after diagnosis.


Here are the things we're going to be confident about with today's video:


1.  How do we begin treating acute appendicitis?


2.  What are the indications and contraindications for nonoperative treatment of appendicitis?


3.  When do we decide to operate for appendicitis?


4.  What are our options when operating for appendicitis?


5.  When do we decide to delay operation with an interval appendectomy?



1.  How do we begin treating acute appendicitis?


Treating appendicitis begins at the bedside with resuscitation, antibiotics and a decision on disposition.



The patient will be made NPO (nil per os) in preparation for possible surgery and intravenous access obtained.


In children I will begin with a 20ml/kg bolus of normal saline and observe to see if the child needs another bolus by looking at heart rate and urine output and hydration level.


In adults 1000ml is a good initial volume unless the patient has comorbid heart failure, if that is the case then I will be more careful with the fluid resuscitation.


Simultaneously we want to begin intravenous antibiotics. 


If suspecting simple appendicitis a second generation cephalosporin is a good choice, if complicated appendicitis is suspected or the patient has SIRS, sepsis or septic shock then piperacillin/tazobactam is a good choice.


Finally, a decision needs to be made.  Are we going to the operating room, the floor or the ICU?



2.  What are the indications and contraindications for nonoperative treatment of appendicitis?