ED Trauma 101: Survey Says…

-Case-
A 25-year-old male is rushed into your ED after a high-speed motor vehicle collision. The patient is hypotensive, tachycardic, and has visible chest bruising. EMS reports a prolonged extrication and poor GCS en route. You don your trauma gown, call out to your team, and prepare to run through the trauma algorithm like your life depends on it (because their’s just might).

-Primary Survey (ABCDE)-
The goal here is to identify and immediately treat life-threatening conditions. You’re not looking for everything – just the killers.

  • Airway with cervical spine protection: Is the airway open and protected? Intubate if altered. Always assume C-spine injury until cleared.
  • Breathing: Look for tension pneumothorax, flail chest, sucking chest wounds. Listen, look, feel, and treat with chest tubes or needle decompression as needed.
  • Circulation: Check for signs of hemorrhagic shock. Assess pulses, control external bleeding, get two large-bore IVs and start fluids or blood.
  • Disability: Rapid neuro exam – GCS, pupils, and motor function.
  • Exposure: Completely undress the patient but keep them warm. Missed injuries hide under clothes.

-Resuscitation-
While you run through ABCDE, you should already be initiating interventions – placing monitors, giving blood if hypotensive, and drawing labs including type and cross.

Adjuncts to Primary Survey:

  • FAST exam to assess for intra-abdominal bleeding
  • Portable CXR and pelvic X-ray
  • EKG if indicated
  • Capnography post-intubation

-Secondary Survey-
Once your patient is stabilized, move to a head-to-toe exam. This is the deep dive. Be methodical.

  • Full history using AMPLE (Allergies, Meds, PMH, Last meal, Events surrounding injury)
  • Head-to-toe exam: scalp lacerations, chest wall deformities, abdominal tenderness, pelvic instability, extremity injuries
  • Repeat vital signs and reassess ABCs frequently

-Definitive Care-
Depending on the injuries, your patient may need emergent surgery, transfer to a trauma center, or ICU-level care. Always maintain a low threshold to escalate.

-Fast Facts-

  • Primary survey saves lives. It’s not about being thorough, it’s about being efficient.
  • ABCDE is your trauma religion. Repeat it often.
  • Secondary survey is where you find the sneaky injuries.
  • Trauma is a team sport. Assign roles and communicate clearly.

You don’t need to find everything right away. You just need to find what’s killing them first!

Want to learn more? Read our in-depth study guide this topic!

Cheers,

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Tamir Zitelny, MD

-References-

  1. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS): Student Course Manual. 10th ed. Chicago, IL: ACS; 2018.
  2. Skinner DL, Laing GL, Bruce JL, et al. Trauma quality improvement: the Pietermaritzburg Metropolitan Trauma Service model. Scand J Surg. 2015;104(2):106-111.
  3. Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018;378(4):370-379.
  4. Guyette FX, Sperry JL, Peitzman AB, et al. Prehospital Blood Product and Crystalloid Resuscitation in Trauma. JAMA Surg. 2021;156(3):e205159.
  5. Harvin JA, Sharpe JP, Croce MA, et al. Pneumothorax Management in Trauma Patients: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2022;92(1):208-218.
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