Table of Contents
- Adjuncts to Primary Survey
- Primary Survey
- Secondary Survey History
- Consciousness level assessment (Disability)
- Life threatening chest injuries to rule out in Breathing Assessment (Primary survey)
- Potentially life threatening chest injuries (Secondary survey)
- Massive hemothorax
- ATLS 80/70/60 rule for palpable blood pressure
- NEXUS criteria and Canadian C-spine rule for C-spine clearance
- Indications of CT head in Minor Head injury (Canadian CT Head Rule)
- Hemorrhagic Shock Stages
- Fat Embolism Syndrome – Gurd’s criteria
- Damage Control Orthopedics (DCO) – Indications

Adjuncts to Primary Survey
PEA COVER
- Pulse oximetry
- EtCO2
- ABG
- Catheter (NG tube and Urethral)
- Output (urinary)
- Vital signs
- ECG
- Radiographs (Chest Xray and Pelvic X-ray)
Primary Survey
ABCDE
- Airway and C-spine protection
- Breathing
- Circulation and control of hemorrhage
- Disability (neurological status)
- Exposure and Environment
Secondary Survey History
AMPLE
- Allergies
- Medications
- Past illness
- Last meal
- Events surrounding the injury
Consciousness level assessment (Disability)
AVPU
- Alert
- Verbal stimuli
- Pain stimuli
- Unresponsive
Life threatening chest injuries to rule out in Breathing Assessment (Primary survey)
ATOM-FC
- Airway obstruction or disruption
- Tension pneumothorax
- Open pneumothorax (sucking chest wound)
- Massive hemothorax
- Flail chest
- Cardiac tamponade
Potentially life threatening chest injuries (Secondary survey)
ATOM-FC
- Aortic injury
- Thorax injuries (non-massive hemothorax, simple pneumothorax)
- Oesophageal perforation
- Muscular diaphragmatic injury
- Fistula (bronchopleural) and other tracheobronchial injury
- Contusion to the heart or lungs
Massive hemothorax
Rule of “3”
Massive hemothorax is defined by the need for thoracotomy guided by volume drained after thoracostomy –
- Initial drainage > 1/3rd of blood volume (>1,500 ml)
- Drainage >3 ml/kg/hr of blood volume over 3 consecutive hours (>200 ml/hr for 3 consecutive hours)
ATLS 80/70/60 rule for palpable blood pressure
NEXUS criteria and Canadian C-spine rule for C-spine clearance
Indications of CT head in Minor Head injury (Canadian CT Head Rule)
VAGABOND
- Vomiting >2 times
- Amnesia before impact >30 minutes
- GCS <15 for >2 hours
- Age >65 years
- Basal skull fracture
- Open skull fracture
- Dangerous mechanism
Hemorrhagic Shock Stages
Think of the scores in a game of tennis: Love โ 15 โ 30 โ 40 โ game over (>40)
- Stage 1: <15% blood loss (<750 ml, considering adult blood volume of 5 L)
- Stage 2: 15-30% blood loss (750-1500 ml)
- Stage 3: 30-40% blood loss (1500-2000 ml)
- Stage 4: >40% blood loss (>2000 ml)
Fat Embolism Syndrome – Gurd’s criteria
CPR RFT FAT EJR
A. Major criteria: CPR
- Cerebral involvement
- Petechial rashes
- Respiratory insufficiency
B. Minor criteria: RFT FAT EJR
- Retinal involvement
- Fever
- Tachycardia
- Fat macroglobulinemia
- Anemia
- Thrombocytopenia
- ESR increased
- Jaundice
- Renal signs
Definitive diagnosis = 1 Major + 4 Minor criteria
Damage Control Orthopedics (DCO) – Indications
ABCDEFGH
a. Acidosis: base deficit >/= 8
b. Blood transfusion: >10 Units of packed cells
c. Cold temperature: <35 c
d. Damage: ABC
- Abdominal and/or pelvic trauma with hemorrhagic shock
- Bilateral lung contusions
- Chest trauma with ISS >20 or ISS >40 without Chest trauma
e. Extremis (ongoing uncontrolled blood loss despite resuscitation) or Unstable (hemodynamically unstable despite initial intervention)
f. Femoral fractures: Bilateral
g. Geriatric patients: >65 years
h. Hours: >90 minutes operative time