In a normal volemic patient, the color returns to normal within two seconds. Extremity hemorrhage should be controlled by direct pressure. Tourniquets may be of value, but the use of clamps directly into the wound should not be employed. Pneumatic splints may be helpful in controlling bleeding as well. Occult bleeding into the major body cavities will result in shock if left unchecked, and bleeding around crush injuries and fractures will also contribute to hypovolemia.
Blast injury can result in arrhythmias.
A brief neurologic examination should be conducted to establish the level of consciousness and the status of the pupils. A more detailed neurologic examination will follow later in the secondary survey. Simply identifying the level of consciousness and the status of the pupils in the primary survey is sufficient. The patient should be completely undressed to facilitate thorough examination and assessment. Supplemental oxygen therapy should be instituted.