Initial Trauma Assessment

OVERVIEW

ATLS approach:

1. Identification of life threatening injuries (primary survey)
2. Resuscitation
3. Head to Toe assessment (secondary survey)
4. Definitive Therapy (+/- transfer)
5. Documentation of injuries post investigations (Tertiary survey)
6. Further appropriate care

• if unable to resolve a problem don’t not leave issue until resolved.
• at any point if there is deterioration start at airway again.

PRIMARY SURVEY

Airway

• air must be able to pass to lungs
  signs: obstruction can occur due to direct injury, oedema, foreign body or depressed LOC
  -> establish airway

Breathing

• ability to ventilate and oxygenate
• signs: absence of breathing, asymmetrical or absent breath sounds, SOB, hyperresonance, dullness, chest wall instability (ATOMFC injuries)
  -> chest drain
  -> SpO2

Circulation

• signs: collapsed or distended neck veins, external haemorrhage (hypovolaemia, cardiac tamponade, external haemorrhage)
  -> IV access -> blood tests, fluid resuscitation (crystalloids -> if unresponsive blood products, compression
  -> ECG, NIBP

Disability

• decreased LOC, pupillary asymmetry, gross weakness
  -> head or spinal cord injury

Exposure

• expose patient
• prevent hypothermia

Other investigations

• xrays: lateral c-spine, CXR, pelvis
• bloods: G+H, Hb, electrolytes, amylase
• N/G or O/G to decompress the stomach once intubated
• foley catheter (contraindicated if: blood at meatus, ecchymosis of scrotum or labium, high riding prostate -> retrograde urethrogram)
• FAST scan: free fluid

SECONDARY SURVEY

• head to toe examination
• if awake take AMPLE history
• exclude (FATAL TRAUMA):

• flail chest
• airway compromise
• tamponade
• air leaks
• lung contusion
• tracheal injury
• ruptured diaphragm
• aortic disruption
• unseen haemorrhage
• myocardial injury
• any neurological injury

Investigations

• laparotomy: haemodynamically unstable + positive FAST
• CT: head, neck, chest, abdo/pelvis (double contrast), aortogram
• angiography: suspected aortic injury, pelvic or retroperitoneal bleeding, organ specific embolisation

Special situations

• burns: first aid, early intubation in airway/inhalation injury, escharotomies
• hypothermia: warm IVF
• high voltage electricity: low threshold for measuring compartment pressures, myoglobinuria

References and Links

• Styner JK. The birth of advanced trauma life support. J Trauma Nurs. 2006 Apr-Jun;13(2):41-4. PMID: 16884131.