ATLS Primary Survey
Posted by dkwinter

What’s your name? What happened?

100% O2 non-rebreather, pulse ox, cardiac monitor, BP, two large bore IVs

Page lab, routine trauma labs including type & screen



        Open or closed

        Protect c-spine

        Assess trachea, trauma, masses, stridor

        Anticipate problems (mass effect, burns) and call for help and/or intubate preemptively

        Chin lift, jaw thrust

        Oropharyngeal airway; may try nasopharyngeal if no facial trauma

        LEMON: Look externally (atypical jaw, hair, obesity); Evaluate 3-3-2 rule; Mallampati; Obstruction; Neck mobility

        Intubate, LMA, king airway or surgical


        Consider OG tube if last meal recently (NG may be ok if no head trauma)



        Jugular vein appearance

        Breath sounds

        Visually inspect chest

        Percuss thorax

        Oxygen saturation

        Blood gas (want PaO2 > 70 mmHg)


        Consider high cervical fracture w/phrenic nerve lesion

        Occlude open pneumothoraces

        Chest tubes as needed

        If tolerating OPA patient will need intubation



        Patient’s color

        Extremities warm or cold

        HR and BP

        Heart sounds

        Examine for bleeding or deformities, don't forget scalp, back, PR, PV


        Examine chest; CXR

        Examine abdomen; FAST or DPL

        Examine pelvis; Pelvic XR

        Examine long bones

        CT if stable

        Call surgery as soon as there's an indication

        IV NS/LR/blood as needed depending on severity of shock

        Place foley to assess resuscitation/perfusion



        Eye exam


        Focal neurological deficit


Exposure and environmental control

        Undress patient completely and apply warm blankets


Secondary survey

        Head to toe exam

        AMPLE history