This document outlines the steps for primary and secondary surveys according to the Advanced Trauma Life Support (ATLS) 9th edition guidelines. The primary survey focuses on assessing and stabilizing the airway, breathing, circulation, disability (level of consciousness), and exposure. Interventions include endotracheal intubation, chest tube insertion, intravenous fluid resuscitation, and monitoring of vital signs. The secondary survey involves a full head-to-toe examination and additional diagnostic imaging tests to evaluate for injuries that may not be evident on primary survey. Reevaluation includes continuous monitoring, pain management, immunizations, and antibiotics as needed.

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ATLS 9th
1° survey
Airway maintenance with C-spine
protection
- Assessment for signs of airway
obstruction
 secretion or blood per
mouth/nose
 stridor
 inspection for foreign bodies
 facial, mandibular, or
tracheal/laryngeal fractures
 severe head injuries
Resuscitation
- rigid suction
- jaw-thrust or chin-lift maneuver
- oropharyngealor nasopharyngeal
airway
- ET tube
- philadephiacollar + inline
immobilization techniques
Circulation & hemorrhage control
- Level of consciousness,skin
color, pulse
- Bleeding
 external hemorrhage
 internal hemorrhage:chest,
abdomen,retroperitoneum,
pelvis, long bones
Resuscitation
- direct manual pressure/suture
- Treat cause
- 2 large-caliber IV catheters,
upper-extremity peripheralIV
access
- warmed crystalloids, bolus of 1-2
L of isotonic solution
- baseline hematologic studies +
G/M
- UPT
- Blood gases and/or lactate level
Breathing & ventilation
- Chest & neck examination
- Auscultation, visual inspection,
palpation, percussion
- Injuries: tension pneumothorax,
flail chest with pulmonary
contusion, massive hemothorax,
open pneumothorax
Resuscitation
- O2 mask with bag ≥11 L/min
- Treat cause
Disability
- Level of consciousness
- Pupillary size & reaction
Exposure & environmental control
- Completely undressed
- Keep warm
Adjuncts to 1° survey and resuscitation
Monitoring
- ECG
- RR, ABG, pulse oximetry, BP
Urinary & gastric catheters
- C/I urinary catheters: blood at the
urethral meatus, perineal
ecchymosis,high-riding or
nonpalpable prostate, pelvic
X-ray examinations & Dx studies
- AP chest& pelvis

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- FAST/DPL fracture
- C/I gastric catheters: cribriform
plate fracture
Consider Need for Patient Transfer
- Diagnosis - Consult
2° survey
- AMPLE - Head-to-toe evaluation
Adjuncts to 2° survey
- Specialized Dx tests
 Additional x-ray examinations of the spine and extremities
 CT scans of the head, chest, abdomen,and spine
Reevaluation
- Continuous monitoring of vital
signs and urinary output
- Relief of severe pain
- Tetanus toxoid
- Antibiotic