Initially written by Dr. Fan Yang (HAEMR Class of 2016) and furthered by Dr. Dana Im (HAEMR Class of 2020):
Wanted to share with you this awesome trauma script that was shared with us last year when we complained about not getting ATLS training early in residency. You will get your ATLS training in Nov/Dec of your PGY-2 year, but hope you will find this script useful when you get pulled into running non acute traumas at BWH during your late intern year or early PGY-2 year. For those 72 year old patients on coumadin who got mistriaged to the hallways at BWH, try to practice this ATLS algorithm when you can, esp when there’s ZERO pressure without angry trauma attendings watching over your shoulders. Let me know if you have any questions!
- AB: Control Active Bleeding
- Ask for Trauma pack if needed
- C: C-collar if not already collared for blunt trauma
“Tell me your full name.”
- If no response try sternal rub.
- Note nasal/oral injuries/burns/obstructions
- Note neck/trache injuries
- Note failure to protect due to low GCS
“His airway is intact.”
- Note chest rise
- Note obvious trauma or emphysema
- Note Pulse Ox
“He has equal breath sounds bilaterally.”
- Begin exposing the patient, note obvious source of bleeding and provide control
- ? Exsanguinating head/facial injury
- ? Distended/tender abdomen
- ? Pelvic instability
- ? Obvious extremity bleeding
- Ask For FAST to come in if not started
- Note HR and BP
- Note skin perfusion or altered level of consciousness surrogates of poor perfusion
“2+ carotid pulses bilaterally (and 2+ radials/DP if time allows)”
(Note any life-threatening bleeding sources as identified)
- Ask to move all extremities, note deficit
- *If obtunded, sternal rub to see if localizes
- *Eye opening
- *Response when asked name (note these are gathering a GCS)
- *Note if he moved to commands or if obtunded or illicit posturing
“GCS 15, pupils 4 mm and reactive bilaterally, no gross deficits.”
- Take off all clothing, examine obvious anterior injury
- For penetrating trauma: early Logroll: Note scalp hematomas. C-T-L spine tenderness, stepoffs, or deformities.
- cover up the patient after each part is examined
- check axilia, GU region, gluteal folds for penetrating injury
- Make sure first full set of vitals
- Ask FAST results
- Summary of events and injuries on primary survey
Preliminary plan of action. (go to the CT now? go to the OR now? intubate? etcetera)
- IV access/Procedure/Foley
- Blood Bank activated? (if needed)
- Radiology/Lab Order placed
- Emergent Consults Called?
“Now I’m going to start my secondary survey.”
There is no evidence of scalp trauma.
Midface is stable (palpate/stress the face here).
TMs clear bilaterally.
No nasal deformities or septal hematoma.
No obvious dental trauma or evidence of jaw malocclusion.
- You can ask someone to hold inline stabilization or tell the patient to not move their head
Trachea is midline.
No cervical spine tenderness in the midline. No stepoffs.
No clavicular deformities. No chest wall tenderness. He has normal chest wall excursion. No crepitus.
As I noted in my primary survey, he has equal breath sounds bilaterally.
Regular rate and rhythm.
Abdomen is soft, non-tender, non-distended. No rebound or guarding.
Pelvis is stable.
2+ femoral pulses bilaterally.
Normal male/female genitalia. No evidence of trauma/gross bleeding.
Palpate all extremities
- Ask the patient to lift up each extremity, push down the gas, etc.
No evidence of trauma, ecchymoses, abrasions or deformities in his lower extremities
2+ DP/PT pulses bilaterally.
No evidence of trauma, ecchymosis, abrasions or deformities in his upper extremities
2+ radial pulses bilaterally.
He has normal strength in his LLE, RLE, LUE, RUE.
Step out of Room
- To CT-scanner
- Reviewed CXR/Pelvic Xray
- Review consults and recommendations
- Review orders and prelim results