Updated September 11, 2025
Introduction
Acute Trauma Life Support (ATLS) provides a structured and regulated approach to managing patients with severe injuries. The goal is to identify and treat life-threatening problems rapidly using the well-established ABCDE framework.
Primary Survey and Resuscitation
Airway and Cervical Spine:
Assess airway patency: clear, partially obstructed, or blocked.
Look for signs of obstruction: snoring, gurgling, stridor, drooling, or hoarseness.
Protect the cervical spine at all times; apply manual immobilization and later a rigid collar.
Management steps: open mouth, clear foreign bodies, suction fluids, insert oropharyngeal tube if no gag reflex, proceed to definitive airway with endotracheal intubation. Surgical airway if needed.
All trauma patients require high-flow oxygen and preparedness for aspiration risk.
Breathing:
Inspect chest movement, symmetry, respiratory effort, skin color, and tracheal position.
Palpate for tenderness, crepitus, surgical emphysema.
Percuss for resonance (pneumothorax) or dullness (haemothorax).
Auscultate both sides for air entry and abnormal sounds.
Immediate management:
Relieve tension pneumothorax with needle decompression.
Seal sucking chest wounds with occlusive dressing.
Treat flail chest with intubation/ventilation.
Manage cardiac tamponade with pericardiocentesis.
Circulation and Haemorrhage Control:
Check carotid, femoral, and radial pulses to estimate systolic pressure.
Look for signs of shock: tachycardia, altered consciousness, cool skin, delayed capillary refill.
Sources of blood loss: external wounds, chest, abdomen, pelvis, femur fractures.
Control bleeding: direct pressure, elevation, pressure points.
Insert two large-bore IV lines (14–16G), give crystalloids cautiously, avoid fluid overload.
Early cross-match for blood, consider hypotensive resuscitation.
Disability (Neurological Assessment):
Rapid evaluation with AVPU or Glasgow Coma Scale.
Check pupils for size, equality, and reactivity.
Look for focal neurological deficits.
Exposure and Environmental Control:
Completely expose patient to detect hidden injuries.
Prevent hypothermia using warm blankets, fluids, and environment control.
Secondary Survey
Once the patient is stabilized, conduct a detailed head-to-toe exam:
Full history (AMPLE: Allergies, Medications, Past history, Last meal, Events).
Physical examination: head, face, spine, chest, abdomen, pelvis, perineum, extremities, neurological system.
Special investigations: X-rays (chest, cervical spine, pelvis), blood tests, CT if indicated.
Summary
The ATLS approach ensures that life-threatening problems are recognized and treated first. The ABCDE method provides a safe, efficient framework for trauma management. After stabilization, a thorough secondary survey and investigations allow for definitive care and prioritization of treatment.
ATLS, acute trauma, trauma management, airway, breathing, circulation, primary survey, secondary survey, resuscitation, emergency medicine, shock, haemorrhage, chest trauma, head injury
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ATLS, Trauma, Emergency Medicine, Resuscitation, Healthcare
: A Step-by-Step Guide to Managing Trauma Patients){kind=link}
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