Initial Assessment and Management of the Trauma Patient

Abstract

The Advanced Trauma Life Support (ATLS) training program was developed to provide uniformity in the assessment and management of trauma patients. Every trauma patient is evaluated using the primary survey, a rapid, reproducible physical exam designed to diagnose those conditions that are immediately life-threatening first. The primary survey consists of the sequential assessment and treatment of “Airway, Breathing, Circulation, Disability, and Exposure/Environment,” represented by the mnemonic “A.B.C.D.E.” The elements of the primary survey must be continually reevaluated in a trauma patient, especially when a patient deteriorates or is transferred to a different location. The uncovering of occult injuries and characterization of injuries, although important, is performed as a lesser priority during the secondary survey, which is represented by the mnemonic “A.M.P.L.E.”: “Allergies, Medications, Past medical problems and surgery, Last Meal, and Events related to the Injury.” The clinician should have a low threshold to return to the primary survey if anything unexpected occurs. Good care of the trauma patient means going “back to the ABCs” as many times as it takes until the patient is truly stable.