ATLS

Asking the patients for his/her name and asking what happened
(Indetifying 10 Seconds assessment)  Appropiate 
A, B, C, D no major compromised
Primary Survey
• Airway maintenance with restriction of cervical spine motion
• Breathing and ventilation
• Circulation and hemorrhage control
• Disability (assessment of neurologic status)
• Exposure/Environmental control
Airway maintenance with restriction of cervical
spine motion
• Asses the airway to ascertain patency  Sign of obstruction?
• Inspecting foreign bodies, mandibular/or tracheal/laryngeal fractures, etc
• Choking  Heimlich maneuver
• Snoring  jaw thrust, consider placement of OPA
• Gurgling  suction
• Stridor  definitive airway?

• Establish definitive airway if there is any doubt about the patient’s

ability to maintain airway integrity
• Prevent excessive movement of the cervical spine  cervical collar
(when airway management is necessary, open cervical collar,
manually restrict motion of the cervical)
Breathing and ventilation
• LOOK, LISTEN, FEEL!

• Examine adequate function of the lung, chest wall, and diaphragm

• Asses JV distention, position of the trachea, chest wall excursion,
expose patient’s neck and chest
• Give supplemental oxygen (use mask reservoir device if the patient is
not intubated)
• Injuries that significantly impair ventilation in the short term : tension
pneumothorax, massive hemothorax, open pneumothorax, tracheal/
bronchial injuries  Identify fast!  decompression
Circulation and hemorrhage control

• Major circulatory compromise in trauma patients  blood volume,

cardiac output, bleeding
• Asses :
• Level of consciousness
• Skin perfusion
• Pulse
• Bleeding : identify external or internal
• External blood loss  direct manual pressure on the wound/tourniquet
• internal bleeding (chest, abdomen, retroperitoneal, pelvis, long bones)
• Identify by physical examination and imaging (x-ray, pelvic x-ray, FAST, or DPL)
• Definitive bleeding control is essential, along with appropriate
replacement of iv volume
• 2 IV line, initiate with crystalloid (should be warmed)  bolus 1L 
unresponsive  blood transfussion
Disability (assessment of neurologic status)

• Patient’s level of consciousness GCS

• Pupillary size and reaction
• Presence of lateralizing sign
• Determines spinal cord injury level (if present)
Exposure/Environmental control

• Completely Undress patient(to assess) -> putting warm blanket to

prevent hypothermia