Trauma Evaluation

Aka: Trauma Evaluation, Primary Trauma Evaluation, Trauma Primary Survey, ATLS

1. See Also
   1. Cardiopulmonary Resuscitation
   2. Secondary Trauma Evaluation
2. Epidemiology
   1. Trauma is the leading cause of death under age 40 years
3. Pitfalls: Common
   1. Inadequate airway maintenance
      1. Inadequate protection of Cervical Spine
      2. Airway obstruction by foreign matter (e.g. blood)
      3. Airway obstruction by Tongue or epiglottis
   2. Inadequate fluid Resuscitation in head injured child
   3. Failure to recognize and treat internal hemorrhage
4. Protocol: Primary Survey
   1. Airway maintenance with C-Spine Control
      1. See Primary Survey Airway Evaluation
   2. Breathing and Ventilation
      1. See Primary Survey Breathing Evaluation
   3. Circulation with Hemorrhage control
      1. See Primary Survey Circulation Evaluation
   4. Disability: Neurologic Status
      1. See Primary Survey Disability Evaluation
   5. Exposure and Environmental Control
      1. See Primary Survey Exposure Evaluation
   6. Trauma Diagnostic Testing
5. Secondary Survey
   1. Obtain Trauma History
   2. Perform Trauma Secondary Survey
6. Protocol: Other initial measures
   1. Urinary Catheterization
   2. Gastric Catheterization
7. Management: Disposition
   1. Decide early if transfer to trauma center is appropiate
      1. Among other criteria, Glasgow Coma Score <= 8 should be cared for at trauma center
      2. Call for transport early in course
   2. Avoid pan-scan (head to Pelvis CT) if Transferring
      1. CT Head
         1. Altered Level of Consciousness (evaluate for intracranial bleeding such as Epidural Hematoma)
      2. Chest XRay
      3. Focused assessment sonography for trauma (FAST)
   3. Perform Primary Survey and secondary survey
   4. Focus on acute stabilization to ensure safe transport
      1. Intubation
         1. Unstable airway
         2. Respiratory distress
         3. Altered mental status
      2. Chest Tubes if indicated
      3. Hemorrhage management
         1. Start Blood Products prior to transfer if indicated or
         2. Give transport paramedics blood to start if needed in route
8. Reference
   1. (2008) ATLS Manual, American College of Surgeons