The document summarizes key aspects of the Advanced Trauma Life Support (ATLS) protocol for assessing trauma patients. The primary survey focuses on identifying life-threatening injuries using the ABCDE mnemonic - Airway, Breathing, Circulation, Disability (neurologic status via Glasgow Coma Scale), and Exposure/Environment. During the primary survey, airway patency, breathing, circulation, and bleeding are evaluated and managed to stabilize the patient before conducting a full secondary survey examination.

1. Subject
Applied surgery
Topic
ATLS AND GCS
By
Advanced trauma life support
Advanced trauma life support is a training
program for medical providers in the
management of acute trauma cases
Primary survey
Madeeha Farooq

2. The first and key part of the assessment of patients presenting
with trauma is called the primary survey. During this time, life-
threatening injuries are identified and
simultaneously resuscitation is begun. A simple
mnemonic, ABCDE, is used as a mnemonic for the order in
which problems should be addressed.
Air way
The first stage of the primary survey is to assess the airway. If
the patient is able to talk, the airway is likely to be clear. If the
patient is unconscious, he/she may not be able to maintain
his/her own airway. The airway can be opened using a chin lift
or jaw thrust. Airway adjuncts may be required. If the airway is
blocked (e.g., by blood or vomit), the fluid must be cleaned out

3. of the patient's mouth by the help of suctioning instruments. In
the case of obstruction, pass an endotrachealtube.
Prehospital
 Tilt the head of patient
 Remove obstruction
 Needle thoracotomy
Hospital management
 Oral airway
 Endotracheal tube intubation
 Tracheostomy
Breathing and ventilation
The chest must be examined by
inspection, palpation, percussion and auscultation. Subcutaneous
emphysema and tracheal deviation must be identified if present.
The aim is to identify and manage six life-threatening thoracic
conditions as Airway Obstruction, Tension Pneumothorax,
Massive Hemothorax, Open Pneumothorax, Flail chest segment
with Pulmonary Contusion and Cardiac Tamponade. Flail chest,
tracheal deviation, penetrating injuries and bruising can be
recognized by inspection. Subcutaneous emphysema can be
recognized by palpation.
Tension Pneumothorax and Hemothorax can be recognized by
percussion and auscultation.

4. pulmonary occlusion
Prehospital
 Remove obstruction
 Mouth to mouth breathing
Hospital management
 Oxygen therapy
 May be invasive or non-invasive
Circulation with bleeding control
 Hemorrhage is the predominant cause of preventable post-
injury deaths.
 Hypovolemic shock is caused by significant blood loss.
 Two large-bore intravenous lines are established
and crystalloid solution may be given.
 If the person does not respond to this, type-specific blood,
or O-negative if this is not available, should be given.
External bleeding is controlled by direct pressure.
 Occult blood loss may be into the chest, abdomen, pelvis or
from the long bones
Prehospital

5.  Check the pulse of patient
 If pulse is absent provide CPR 30:2
Hospital management
 CPR
 Pass iv line
 Give fluids (blood is ideal fluid)
 For life saving R/L can be given send baseline
investigations
 CBC, LFT, RFT, serume electrolytes and other blood
investigations
 Epinephrine, dopamine, dobutamine can also be given for
increasing contractility of heart.
Deforming life threality
Primary survey
 Aim to manage life threatening diseases before stabilization

6.  GCS calculations
 Ultrasound, x ray, CT scan can be performed.
Secondary survey
Thoroughly examine patient from head to toe
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a clinical scale used to
reliably measure a person's level of consciousness after a
brain injury. The GCS assesses a person based on their ability
to perform eye movements, speak, and move their body.

7. References
 The Royal College of Surgeons of England. Advanced
Trauma Life Support® (ATLS®)
 Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm
J (October 2004). "[The importance of Advanced
Trauma Life Support (ATLS) in the emergency room]".
Der Unfallchirurg (in German). 107 (10): 844–50.
doi:10.1007/s00113-004-0847-2. PMID 15452655.
S2CID 36286887.

8.  Rotondo, Michael. "About ATLS". The American
College of Surgeons. The American College of
Surgeons. Retrieved 1 September 2020.