The trauma assessment according to ATLS guidelines typically consists of a primary survey and a secondary survey.

Primary Survey

The primary survey is a rapid but thorough evaluation designed to identify and manage immediate life-threatening injuries or conditions. The following mnemonic, known as the "ABCDE" approach, is used to guide the primary survey:

• Airway with cervical spine protection: The first step is to assess the patency of the patient's airway and ensure there is no obstruction. If a cervical spine injury is suspected, manual stabilization is maintained throughout the assessment.
• Breathing and ventilation: Evaluate the patient's breathing, looking for signs of respiratory distress, such as inadequate or absent breath sounds, decreased oxygen saturation, or abnormal breathing patterns. Address any life-threatening breathing issues promptly.
• Circulation with hemorrhage control: Assess the patient's circulation by checking their pulse, blood pressure, and skin perfusion. Control any external bleeding and initiate intravenous access for fluid resuscitation if necessary.
• Disability: Evaluate the patient's neurological status, including their level of consciousness, pupillary response, and motor function. This step helps identify any signs of head injury or neurologic compromise.
• Exposure and environmental control: Remove the patient's clothing to perform a comprehensive examination and maintain appropriate body temperature through the use of blankets or other methods.

Secondary Survey

The secondary survey is a more detailed and comprehensive assessment conducted once the primary survey has addressed any immediate life-threatening issues. It involves a head-to-toe examination, including a thorough medical history, a complete physical examination, and any necessary imaging or diagnostic studies. The secondary survey focuses on identifying less obvious injuries that may require treatment and ensures that no injuries are missed.

During the secondary survey, the following components are considered:

• Detailed history: Gather information about the mechanism of injury, associated symptoms, and any pertinent medical history.
• Head and neck examination: Inspect and palpate the head and neck for signs of trauma, including scalp lacerations, skull fractures, or neck injuries.
• Chest examination: Assess the chest for injuries, such as flail chest, pneumothorax, or hemothorax. Evaluate symmetry of breathing, percussion, breath sounds and perform chest X-rays if necessary.
• Abdominal examination: Palpate the abdomen for tenderness, rigidity, or signs of internal bleeding. Additional imaging studies like ultrasound or CT scans may be required.
• Pelvic examination: Assess the pelvis for instability or fractures. Apply pelvic binders if indicated.
• Extremity examination: Inspect and palpate all extremities for fractures, dislocations, or vascular injuries.
• Neurological examination: Perform a thorough neurological assessment to identify any focal deficits or signs of spinal cord injury.