ATLS Primary Survey
Trauma deaths have a trimodal distribution
First peak (~50%) Within minutes of injury Due to major neurological or vascular injury Medical treatment can rarely improve outcome
Second peak (~30%) Occurs during the 'golden hour' Due to intracranial haematoma, major thoracic or abdominal injury Primary focus of intervention for the Advanced Trauma Life Support (ATLS) methodology
Third peak (~20%) Occurs after days or weeks Due to sepsis and multiple organ failure ATLS methodology
Primary survey and resuscitation (ABCDE) A = Airway and Cervical spine B = Breathing C = Circulation and Hemorrhage control D = Disability or Dysfunction of the CNS E = Exposure
Airway & Cervical spine
Ask the patient a question - if the patient can talk, then he is able to protect own airway
If the airway is compromised: initially attempt a chin lift and clear airway of foreign bodies If gag reflex is present: insert nasopharyngeal airway If no gag reflex is present: endotracheal intubation If unable to intubate: cricothyroidotomy
Consider administering 100% oxygen
- Always assume that patient has cervical spine injury
Place in hard collar and keep on until cervical spine has been 'cleared'
Check position of trachea - is it midline? Assess the respiratory rate and work of breathing and air entry Evaluate breath sounds - present bilaterally? Equal air movement bilaterally?
If clinical evidence of tension pneumothorax: * need decompression with venous cannula through 2nd intercostal space in the midclavicular line If open chest wound: * seal with occlusive dressing
Circulation & Hemorrhage control
Assess pulses: Check the femoral pulses first (if present, BP likely > 60); then dorsalis pedis; then capillary return and state of neck veins
Identify exsanguinating haemorrhage and apply direct pressure Place two large bore intravenous cannulas Take venous blood for FBC, U+Es, and Cross match Take sample for arterial blood gasses Give intravenous fluids (Crystalloid or colloid in adequate volume) Attach patient to ECG monitor Insert urinary catheter
Dysfunction Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive Assess pupil size, equality and responsiveness
Evaluate GCS score - this may need to be completed earlier in the evaluation if possibility of intubation
Exposure Fully undress patients Avoid hypothermia
Notes & References
Credits & Notices
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