Trauma Primary Survey (ATLS)

cABCDE approach

Red flags
  • Exsanguinating haemorrhage
  • Airway compromise
  • Tension pneumo, massive haemothorax, tamponade, flail

First steps

  • <c>: catastrophic haemorrhage control (tourniquet, direct pressure, TXA 1 g IV)
  • A: airway + C-spine control
  • B: breathing
  • C: circulation (2 large-bore IV, cross-match, permissive hypotension in penetrating)
  • D: disability (GCS, pupils, glucose)
  • E: exposure + prevent hypothermia

Key investigations

  • FAST scan
  • Trauma CT (pan-scan)
  • Blood, group & save, coag, ABG, β-hCG

Differentials

  • Occult injuries — reassess frequently

Initial management

  • Massive transfusion 1:1:1 (RBC:FFP:Platelets)
  • TXA within 3 h
  • Damage control surgery if unstable
  • Log roll for secondary survey

Referral

  • Trauma team activation, specialty as per injury
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