Professional Documents
Culture Documents
Primary Survey
OBJECTIVES OF ATLS
Assess the patients condition rapidly and
accurately
Resuscitate and stabilize the patient according to
priority
Determine if the patients needs exceed a facilitys
capacity
Arrange appropriately for the patients inter-
hospital transfer
Assure that optimum care is provided and that the
level of care does not deteriorate at any point
during the evaluation, resuscitation, or transfer
What are the stages of ATLS?
Preparation
Triage
Primary survey (ABCDE)
Resuscitation
Adjuncts to primary survey & resuscitation
Secondary survey (Head to toe Evaluation)
Adjuncts to secondary survey
Continued post-resuscitation monitoring and
reevaluation
Definitive care
How do you triage patients in
Trauma?
Use trauma scoring systems to triage
The Revised Trauma Score is made up of
a three categories: GCS, Systolic blood
pressure, and respiratory rate. The score
range is 0-12. A patient with an RTS
score of 12 is labeled delayed, 11 is
urgent, and 10-3 is immediate. Those
who have an RTS below 3 are declared
dead.
6
5 second Round??
Pt is conscious or not
Airway
Ventilation
Signs of massive external
hemorrhage
Any deformity
Skin color and temp and feel a pulse
What is the Golden Hour in trauma?
"There is a golden hour between life
and death. If you are critically
injured you have less than 60
minutes to survive. You might not
die right then; it may be three days
or two weeks later -- but something
has happened in your body that is
irreparable."
- R Adams Cowley
What are the 5 key components of the primary survey in
major trauma?
Early:
Epi/Subdural hematoma, Hemopneumothorax Pelvic/limb
fractures, Abdominal injuries
Late:
Sepsis / Multiple Organ Failure
Which Injuries should be identified
in the Primary survey?
1. Tension pneumothorax
2. Flail chest with pulmonary contusion
3. Massive hemothorax
4. Open pneumothorax
What does airway maintenance with cervical spine control involve in a patient with trauma?
Wheezing
Sonorous sounds
Stridor
Cough
Dysphonia
Accessory muscle use
Drooling of saliva
What do you do if patient is breathing in
gasps or suddenly stops?
Level of consciousness
Skin color
Pulse ( quality, rate, regularity )
Capillary refill
Neck veins
If you can feel the carotids, what is
the likely SBP?
Hypothermia
Dilution Coagulopathies
Dislodgement of thrombus
What does disability (neurological
evaluation) involve?
AVPU
Assess GCS and document its components (e.g. E4,
V5, M6 = GCS 15)
Assess pupillary size and responsiveness (if you can
open the eyelids due to swelling, consider using
ocular ultrasound)
Assess gross motor and sensory function in all 4
limbs
How do you check for spinal injury?
LOG ROLL
Absence of limb movements. Check for priapism, loss
of anal sphincter tone.
What does exposure and environmental
control involve?
While maintaining thermostasis, completely
expose the patient
If not yet done, consider log-rolling the patient now
Areas where potentially life threating injuries can
be missed are:
Back of head
Back
Buttocks
Perineum
Axillae
Skin folds
Which investigations can be done as
adjuncts to primary survey?
Electrocardiographic Monitoring.
Urinary Catheter
Gastric Catheter
Monitoring
ABG
Pulse oximeter
Blood pressure
X-rays
AP CXR
AP pelvis
C-spine
Diagnostic peritoneal lavage
Abdominal ultrasonography (FAST)
The well practiced
trauma team
should aim to
complete the
primary survey in
less than 10
minutes
Illinois EMSC 30
Hemorrhage classification
Class % blood Heart rate Blood Pulse Resp rate Capillary Urine Other Mortality
loss pressure pressure refill output
I 10 19 Normal
(750 cc)
II 20 29 >100 Slightly Delayed
(1250)