An introduction to the initial hospital management of acute trauma

A- Airway and cervical spine control

B- Breathing & ventilation

C- Circulation and haemorrhage control

D- Disablilty: Central Nervous System dysfunction

E- Exposure / Environmental control

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  Secondary survey: ‘head to toe’
  
• 
  Definitive treatment
  
• 
  Tertiary survey: Next day to ensure nothing is missed.
  

Because of the large range of possible pathologies and treatments, to avoid being didactic we have presented ‘treatment options’ to be considered in each section. This article is intended for the non-specialist as an introduction to the hospital management of acute trauma. We would encourage all junior doctors who may manage trauma to attend an ATLS course.

Primary survey

Once the patient arrives, everyone should listen to the handover from the ambulance crew. The organized, systematic ATLS primary survey protocol should be used to identify and treat life threatening injuries. If vital signs change, the primary survey should start again at the ‘top’ ie airway and proceed down. In this way the team leader continuously re-evaluates his/her findings as patients may deteriorate or change rapidly.

If the patient is on a spinal board or scoop for immobilisation, it must be removed using a ‘scoop to ski’ technique as prolonged use of this device can cause serious pressure sores.