ATLS Primary Survey

From TraumaWiki.com

Contents 1 Introduction 2 Basic Information 3 Notes & References 4 Credits & Notices

Introduction

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

Basic Information

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'

Breathing

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

Authors-contributors to this page (listed alphabetically, last name, first & middle initial only, no institutional affiliations, no scientific titles):

Stawicki SP

Please make sure you look at the existing references before editing to avoid listing the same citation more than once. The order of references is not important as long as the appropriate reference number in the text points to the correct reference number in the references section.