Trauma Assessment
The ATLS primary survey uses a systematic ABCDE approach to identify and treat life-threatening injuries before a detailed history or head-to-toe examination.
✦ The Mnemonic
"ABCDE Saves Trauma Lives"
Airway · Breathing · Circulation · Disability · Exposure — the ATLS primary survey
Clinical Breakdown
The AMPLE history (for secondary survey): Allergies, Medications, Past medical history, Last meal, Events and mechanism of injury. Mechanism guides injury prediction — high-speed RTA, fall from height, blast injury, penetrating trauma each have characteristic injury patterns.
Immediate B-threats in trauma: Tension pneumothorax (needle decompression 2nd ICS MCL, then chest drain), Open pneumothorax (3-sided dressing → chest drain), Massive haemothorax (>1.5L blood; chest drain; thoracotomy if draining rapidly), Flail chest (paradoxical movement; pain relief; early intubation if failing).
Damage control resuscitation: in haemorrhagic shock, avoid large-volume crystalloid (dilutes clotting factors, worsens acidosis, causes hypothermia). Use MTP (massive transfusion protocol): packed RBCs : FFP : platelets in 1:1:1 ratio. Permissive hypotension (MAP 50–65 mmHg) until haemorrhage controlled.
⭐ Clinical Pearl
REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta): an endovascular balloon inflated in the aorta (Zones I, III, or V) to temporise haemorrhage from below the balloon while the patient reaches the operating room. An emerging alternative to open resuscitative thoracotomy for sub-diaphragmatic haemorrhage. Reduces distal ischaemia compared to aortic cross-clamping.