Assessing the Patient Initial Steps

The assessment of a patient with potential toxic trauma should follow the approach taken for the management of physical trauma and should include an initial flash and primary and secondary assessments. In particular, the overall conscious state of the patient and evidence of response together with respiratory status should be assessed immediately. 

The flash assessment of the patient should include observation of whether there is evidence of continuing contamination. This may be obvious due to liquid stains and smell. Contaminated clothing should be removed immediately by protected persoimel as part of the decontamination process. Removal of contaminated clothing reduces contamination by about 80 % as discussed in Chap. 4. 

The ABCDE system used in advanced trauma life support remains a useful structure for both primaiy and secondary surveys in cases of toxic trauma, but certain factors in the acronym may have determining effects on the others. 

Unconsciousness can affect the assessment of disability and the ability to maintain an airway (since the airway and respiratory reflexes may be affected by the unconscious level). The level of unconsciousness in a presenting patient who may have suffered toxic trauma should be assessed immediately after admission, using AVPU and the Glasgow Coma Scale (GCS see Sect. 7.5.1). 

Early pre-hospital management should emphasise the assessment of conscious level as a baseline and for the requirement for immediate steps to maintain the airway, even when no equipment is available (e.g. placing the patient in the left lateral position and holding the chin up). 

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