TrAPPTrAPP
    Get Started
    Back to Algorithms

    ATLS Primary Survey Protocol

    Advanced Trauma Life Support - Systematic Approach to Trauma Assessment

    Work through the ATLS primary survey, from airway with cervical spine protection through breathing, circulation, disability, and exposure.

    A
    Airway with C-spine Protection

    Assessment Questions

    • Is the airway patent?
    • Can the patient speak clearly?
    • Are there signs of obstruction?
    • Is there stridor or abnormal breathing sounds?

    Immediate Actions

    • Maintain cervical spine immobilization
    • Remove foreign objects if visible
    • Consider jaw thrust or chin lift
    • Prepare for advanced airway if needed

    Critical Red Flags

    • Complete airway obstruction
    • Severe facial trauma
    • Expanding neck hematoma
    • Inability to speak or altered voice

    B
    Breathing and Ventilation

    Assessment Questions

    • Is the patient breathing adequately?
    • What is the respiratory rate and effort?
    • Are breath sounds equal bilaterally?
    • Is there chest wall movement symmetry?

    Immediate Actions

    • Provide high-flow oxygen
    • Assess for tension pneumothorax
    • Check for flail chest
    • Consider needle decompression if indicated

    Critical Red Flags

    • Absent breath sounds
    • Severe respiratory distress
    • Cyanosis
    • Tracheal deviation

    C
    Circulation with Hemorrhage Control

    Assessment Questions

    • What is the pulse rate and quality?
    • What is the blood pressure?
    • Is there evidence of external bleeding?
    • What is the skin color and temperature?

    Immediate Actions

    • Control external hemorrhage
    • Establish IV access (2 large bore)
    • Assess for signs of shock
    • Consider blood products if indicated

    Critical Red Flags

    • Weak or absent pulse
    • Hypotension
    • Active external bleeding
    • Signs of internal bleeding

    D
    Disability/Neurologic Assessment

    Assessment Questions

    • What is the Glasgow Coma Scale?
    • Are pupils equal and reactive?
    • Is there focal neurologic deficit?
    • Is there evidence of spinal cord injury?

    Immediate Actions

    • Calculate GCS score
    • Check pupil size and reactivity
    • Assess motor and sensory function
    • Maintain spinal immobilization

    Critical Red Flags

    • GCS < 13
    • Unequal or non-reactive pupils
    • Focal neurologic deficits
    • Signs of increased ICP

    E
    Exposure/Environmental Control

    Assessment Questions

    • Are there any additional injuries?
    • Is the patient hypothermic?
    • Are there signs of abuse or violence?
    • Is there environmental hazard exposure?

    Immediate Actions

    • Completely undress the patient
    • Prevent hypothermia
    • Log roll to examine back
    • Document all injuries found

    Critical Red Flags

    • Hypothermia
    • Multiple trauma patterns
    • Hidden injuries
    • Environmental toxin exposure

    Remember: Primary Survey Priorities

    • • Life-threatening conditions must be identified and treated immediately
    • • Complete the primary survey before moving to secondary assessment
    • • Reassess frequently - patients can deteriorate rapidly
    • • Don't get distracted by obvious but non-life-threatening injuries
    • • Consider early activation of massive transfusion protocol if indicated

    Related learning

    Earn CME on this topic
    TrAPP editorial standards