ATLS Master 2
Primary survey - ANS Brief history: age, gender, mechanism of injury (what led to the injury)
Airway Maintenance with * Restriction of Cervical Spine Motion *
• Breathing and Ventilation
• Circulation with Hemorrhage Control
• Disability (Neurologic Evaluation)
• Exposure and Environmental Control
Clinicians can quickly assess A, B, C, and D in a trauma patient (10-second assessment) by
identifying themselves, asking the patient for his or her name,
and asking what happened
*AIRWAY*
Upper airway (above vocal cords) managed adjunctively with chin lift/jaw thrust, suctioning, oral
airway, nasopharyngeal airway, and laryngeal mask airway. The most common cause of airway
obstruction in the unconscious patient is the tongue.
Lower airway managed definitively with a cuffed tube in the trachea (orotracheal intubation,
nasotracheal intubation, or surgical airway—cricothyrotomy)
intubate GCS <9
*Breathing (oxygenation and ventilation)*
▪ Look, listen, feel... include trach position and neck veins, 02 sat (put on pulse ox!!!0.... (ABG)
▪ Oxygen, bag and mask, hyperventilate prn (for inc ICP use req intubation)
Circulation
▪ BP, pulse, skin, temp, cap refill, ECG
▪ Stop bleeding (pressure, tourniquet)
2 large boor IV cannulas, 2 L ringers STAT
,Put in a FOLEY
Consider and intervene to *stop hidden sources of bleeding.*
Chest: chest tube
Abdomen- FAST
Pelvis: pelvic binder
Long bone fracture: reduce and splint
Disability
▪ Alert, Verbal, Pain, Unresponsive
▪ Pupil size and reactivity, movement of limbs
Temporize for evidence of increased intracranial pressure.
Elevate head of bed.
Mild hyperventilation to paCO2 = 35
Mannitol (1 gm/kg)
Neurosurgical consultation
▪ Exposure (keep warm)
Remove all clothing to facilitate access and examination.
Maintain normothermia/prevent hypothermia: warm room, warm fluids, warm blank
secondary survey - ANS • Secondary survey (head-to-toe evaluation and
patient history)
Secondary Survey
Complete, head-to-toe physical examination to identify all anatomic injuries
Begins after primary survey & resuscitation have been completed and patient is sustaining
satisfactory physiology
History
Allergies
Medications, particularly cardiac, anticoagulation, and diabetic medications
Past medical history/pregnancy
Last meal eaten
Events/environmental (more detailed mechanism of injury, helps to define injury patterns)
Blunt
Motor vehicle
Pedestrian
,Fall
Crush
Penetrating
Gunshot
Shotgun
Stab
Environmental
Burn
Cold
Chemical, radiological, biological
Primary pressure wave (blast)
Explosions combine all four mechanisms of injury and produce multi-dimensional injuries.
Physical exam
Head
Mental status: GCS
Scalp
Lacerations and avulsions
Open skull fractures
Eyes
Visual acuity: the vital sign of the eye
Pupil size & reactivity
Globe integrity & foreign body assessment
Extraocular muscle movement
Ears
Pinna
External auditory canal
Hemotympanum and tympanic membrane rupture
Face
Nose
Epistaxis
Septal hematoma
Fracture
Mouth
Mid-face stability
Malocclusion
Dental fractures
Mandibular fractures
Tongue lacerations
Neck: maintain in-line stabilization as anterior and posterior collar sections are temporarily
removed for neck exam
Anterior
Laryngeal deformity
Subcutaneous emphysema
Hematoma
, Bruit
Posterior
Cervical spine tenderness
Paravertebral swelling
Chest
Breath sounds
Hyper-resonance or dullness to percussion
Rib, sternal, and clavicular fractures
Subcutaneous emphysema
Abdomen
Scars and open wounds
Distention
Tenderness
Peritoneal signs
Pelvis
Bony tenderness and stability
Perineum/genitalia: stigmata of urethral injury and pelvic fracture
Hematoma/bruising
Blood at urethral meatus
Vaginal lacerations
Scrotal hematoma
Anorectum
Anal tone
transfer to trauma - ANS GCS 13 or less
SBP 90 or less
breaths less than 10 or more than 30
Penetrating trauma
Chest wall or pelvic instability
open or epressed skull fracture
2+
Fall > 20 feet (2 stories)
high risk MCPs
airway - ANS Upon initial evaluation of a trauma patient, first assess
the airway to ascertain patency. This rapid assessment
for signs of airway obstruction includes inspecting for
foreign bodies; identifying facial, mandibular, and/or
tracheal/laryngeal fractures and other injuries that
can result in airway obstruction; and suctioning to
clear accumulated blood or secretions hat may lead