Trauma Protocol - ATLS Primary Survey
Systematic approach to trauma assessment and management using Advanced Trauma Life Support principles
Golden Hour - Time is Critical!
Primary Survey (ABCDE)
A
Airway with C-spine protection
- •Maintain C-spine immobilization
- •Open airway (jaw thrust if trauma)
- •Clear foreign bodies/secretions
- •Consider advanced airway if GCS <8
- •Apply cervical collar
If airway compromised, address immediately before proceeding
B
Breathing and Ventilation
- •Assess respiratory rate and effort
- •Auscultate bilateral breath sounds
- •High-flow oxygen 15L/min
- •Decompress tension pneumothorax
- •Seal open chest wounds
Look for life-threatening chest injuries
C
Circulation with hemorrhage control
- •Control external bleeding (direct pressure, tourniquet)
- •Assess pulse quality and rate
- •Establish 2 large bore IVs
- •Fluid resuscitation (balanced approach)
- •Consider blood products early
Blood on the Floor + 4 more: Chest, Abdomen, Pelvis, Long bones/Femur. TCP - Tourniquet—check, Compression—check dressing, Pelvic—apply SAM pelvic splint, Arresting/Joints (autoreturn or lower limb injuries)
D
Disability (Neurological)
- •GCS assessment
- •Pupil size and reactivity
- •Motor and sensory exam
- •Check blood glucose
- •Protect from secondary injury
Prevent secondary brain injury - maintain BP and oxygenation
E
Exposure and Environmental control
- •Remove all clothing for exam
- •Log roll to examine back
- •Prevent hypothermia
- •Cover with warm blankets
- •Warm IV fluids if available
Hypothermia worsens coagulopathy and acidosis
Vital Signs Monitoring
Shock Classification
Damage Control Resuscitation
Massive Transfusion Protocol
• 1:1:1 ratio (RBC:FFP:Platelets)
• Early TXA within 3 hours
• Target Hgb 7-9 g/dL
• Warm all products
Fluid Resuscitation
• Balanced crystalloids preferred
• Limit to 1-2L initially
• Permissive hypotension if no TBI
• Consider hypertonic saline
Lethal Triad
• Hypothermia < 35°C
• Acidosis pH < 7.2
• Coagulopathy INR > 1.5
Penetrating Trauma
- •Do NOT remove impaled objects
- •Mark entry/exit wounds
- •Consider trajectory
- •Early surgical consultation
- •Minimize on-scene time
Blunt Trauma
- •High index of suspicion for internal injuries
- •FAST exam if available
- •Consider mechanism of injury
- •Serial abdominal exams
- •Monitor for delayed presentation
Head Trauma
- •Maintain SBP >100 for adults
- •Avoid hypoxia (SpO2 >90%)
- •Avoid hyperventilation
- •Head elevation 30° if no shock
- •Early neurosurgery consultation