<prompt> In triage of school bus accident of children, which one will you attend first and give priority?Airway obstruction of childBoy in shockFlair chest childSevere head injury  <response>: ANS. A Evaluation of a trauma victimPrimary survey in trauma Focused history and physical examination secondary surveyThe focused history and physical examination includes a physical examination that focuses on a specific injury or medical complaint, or it may be a rapid examination of the entire body.It also includes obtaining a patient history and vital signs.Patient history: A patient history includes any information relating to the current complaint or condition, as well as past medical problems that could be related. Utilize bystandersfamily... when needed.Acronym to obtain a patients history:S: SignssymptomsA: AllergiesM: MedicationsP: Pertinent past medical historyL: Last oral intakeE: Events leading to the illness or injuryRapid assessment: This a quick, less detailed head-to-toe assessment of the most critical patients.Focused assessment: This is an examination conducted on stable patients. It focuses on a specific injury or medical complaint.Vital signs: This include pulse, respirations, skin signs, pupils, and blood pressure. This may include documenting the oxygen saturation level this is highly useful when dealing with chemical agent exposure.Pulse: Assess for rate, rhythm, and strength.Respiration: Assess for rate, depth, sound, and ease of breathing.Skin signs: Assess for color, temperature, and moisture.Pupils: Check pupils for size, equality, and reaction to light.Constricted pupils in a mass casualty event are highly suggestive of nerve agentorganophosphate toxicity.Head-to toe examination of a trauma patient with significant MOI--The physical examination of the patient should take not more than two to three minutes.Chain of survival Note: The boxes bordered with dashed lines are performed by healthcare providers and not by lay rescuers To simplify Treatment of unstable tachycardia: Synchronized DC version Treatment of stable tachycardia: Drugs and carotid massage Treatment of unstable bradycardia: Transcutaneous pacing medical pacing atropine 0.5 mg up to 3 mg or injection adrenaline 2-20 mgkgmin or injection dopamine 2-20 mgkgmin Treatment of stable bradycardia: Expert consultation for identifying cause. How to say a patient is stable or not look for CHAPS1. Chest pain2. Hypotension 90 mm Hg3. Altered mental status4. Pulmonary signs of cardiac failure crepitations5. Signs of shock cold and clammy extremities Important imaging questions potential to be asked from emergenciesHamptons hump pulmonary embolismGlasgow coma scaleObservationResponseScoreEyesOpen spontaneously4Open to speech3Open to painful stimulus2No response no eye opening1VerbalResponds sensibly5Confused4Inappropriate words3Incomprehensible sounds2No response silent1MotorObeys commands6Points localizes to pain5Withdraws from pain4Bend limbs in response to pain flexion3Straighten limbs in response to pain extension2No response1 Nexus criteria is used in evaluating a case of suspectedC-spine injuryNexus criteria1. Absence of tenderness in the posterior midline2. Absence of a neurological deficit3. Normal level of alertness GCS score 154. No evidence of intoxication drugs or alcohol5. No distracting injurypain Patient who fulfilled all 5 of the criteria were considered low risk for C-spine injury- No need C-spine X-ray For patients who had any of the 5 criteria- Radiographic imaging was indicatedAP, lateral and open mouth views Focussed abdominal sonography in trauma FAST FAST positive e-FAST extended FASTIncludes FAST along with lung ultrasound to detect any life-threatening emergencies like pneumothorax. Findings in e-FASTNormal seashore pattern Pneumothorax showing barcode sign 