Summary
The primary survey is designed to rapidly identify and address life-threatening problems. Its priorities are:
- Airway with Cervical Spine Protection
- Breathing and Ventilation
- Circulation with Hemorrhage Control
- Disability (Neurological Status)
- Exposure/Environmental Control
At a Glance
| Priority | Focus |
|---|
| Airway | Ensure a patent airway while protecting the cervical spine |
| Breathing | Assess and support adequate ventilation; identify pneumothorax, hemothorax, and other injuries |
| Circulation | Identify and manage hemorrhage and shock; start resuscitation |
| Disability | Evaluate neurological status quickly (using tools like AVPU or GCS) |
| Exposure | Fully expose the patient to assess for hidden injuries while preventing hypothermia |
Detailed Explanation
Airway with Cervical Spine Protection
The first priority is to establish a secure airway. This includes promptly ensuring the airway is patent and protecting the cervical spine in trauma patients because of the high risk of cervical spine injury. Early airway compromise is the most immediate life threat and must be addressed immediately 1.
Breathing and Ventilation
After securing the airway, quickly assess the patient's breathing. Evaluate for signs of inadequate ventilation or chest injuries such as flail chest, pneumothorax, or hemothorax. Rapid identification and management of these issues can prevent hypoxia and further deterioration 1.
Circulation with Hemorrhage Control
Circulation is assessed next. This step involves the rapid identification of hemorrhage and initiation of hemorrhage control measures along with fluid resuscitation when indicated. Shock, particularly hemorrhagic shock, poses an immediate threat to life and must be managed promptly 2.
Disability (Neurological Status)
A brief neurological examination is performed to assess the patient’s level of consciousness and identify any focal deficits. This evaluation helps determine the severity of head or spinal injuries. Common tools include the AVPU scale or the Glasgow Coma Scale (GCS) 2.
Exposure/Environmental Control
Finally, the patient is completely exposed to assess for other injuries that may have been hidden by clothing. Throughout this process, care is taken to prevent hypothermia, which can exacerbate bleeding and worsen patient outcomes 1.
These steps form the basis of the ATLS primary survey and are critical for the early management of trauma patients in the emergency setting.