ATLS
Primary Survey
- A - Airway- chin lift, oral airway, nasal airway jaw thrust, 100% O2, suction, r/o FB, are attempted first to improve O2 SAT. Follow pulse Ox readings. - C-spine- immobilize, inline stabilization for intubation.
- B - Breathing- check for breath sounds, midline trachea, resonance. Needle (angiocatheter) thoracostomy if TPNX is suspected. ETT as indicated by A and B. Orotracheal intubation is a preferred mode. Contraindicated if significant C-spine trauma is suspected. Nasotracheal intubation has some contraindications such as facial trauma and apnea - the latter being an absolute contraindication.
- C - Circulation- color, pulse, BP bilaterally, cap refill, cardiac monitor. Give IVF or PRBC prn
- IV - 14/16 gauge angiocaths bilaterally, LABS, fluids. LABS are: CBC, PT/PTT, Lytes, Bun/Cr, UPT, UA, T&X, LFT, ETOH, TOX screen, Ca/Mg, CPK, Amylase.
- D - Disability-GCS, AVPU (Alert, Voice response, Pain response, Unresponsive), Coma Protocol, AOB, FS.
- E - Expose- look for gross deformities, MD alert tags, splint and cleanse the wound. Additional as needed and as pt's condition permits
- F /G - Foley for UA, UPT, IV fluid monitoring. Insert after r/o urethral fx ( blood at meatus, high riding prostate on rectal exam). G - Gastric tube.
NOTE!!!
ABC steps in primary survey are corrected without going to next step. It is during primary survey that we order lateral C-spine, chest and pelvic Xrays. DPL or US, when needed is also done during primary survey
Secondary Survey
Obtain the following: Hx - obtain detailed history
A - allergies M - meds P - pmhx L - last meal I - immunizations ( Td)
Perform physical exam and observe the following:
HEENT - observe for Battle's sign, Raccoon eyes, fundic exam, pupils, hemotympanum, otorrhea, AOB, sclera, MS,
NECK - observe for JVD, rigidity ( Brudzinsky ), trachea, stridor, hoarse voice, Cervical spine stepoffs, crepitus
CV - observe for S1S2, regular pulses, muffled heart sounds, BP bilaterally, orthostatics, monitor, EKG
PULM - observe for dullness, resonance, flail chest, sq emphysema, rales/ronchi/crepitus
ABDO - look for masses, scars, guarding, rebound, distended
EXTR - observe and look for deformity, pulses, cyanosis, N/V status, tenting of the skin, splint the wound
NEUR - document GCS, AOB, DTR, sphincter tone, Babinski,
SKIN - note if any needle tracks, petechiae,
PELV - see if stable or unstable
GENIT - assess for scrotal hematoma or swelling, blood in meatus
RECTAL - assess tone, guaiac, high-riding prostate
GLASGOW COMA SCALE (GCS)