â¶What is the ATLS primary survey and how do I perform it?
ATLS (Advanced Trauma Life Support) is the systematic assessment of a trauma patient. Primary survey: (A) Airway with C-spine protectionâis the airway patent? Is the patient talking or making sound? Clear obstructions, position jaw, consider airway adjuncts. (B) Breathingâis the patient breathing? Look for chest rise, listen for breath sounds, palpate for rib fractures, tension pneumothorax, flail chest. (C) Circulationâcheck for pulse, control bleeding, assess perfusion (color, warmth, cap refill). (D) Disabilityâlevel of consciousness (AVPU: Alert, Verbal, Pain, Unresponsive), pupils, spinal cord injury signs. (E) Exposureâundress the patient, log-roll to check back, avoid hypothermia. Primary survey takes 60â90 seconds; life threats are identified and treated immediately.
â¶How do I control hemorrhage and when do I use a tourniquet?
Life-threatening bleeding goes: (1) Direct pressure with a clean cloth or hemostatic gauze; maintain pressure for 3â5 minutes without peeking. (2) Elevate the limb above the heart if possible. (3) Apply a tourniquet on an extremity if direct pressure fails or there is arterial spurting, amputation, or a penetrating wound to an extremity that will not stop with pressure. Place the tourniquet 2â3 inches above the bleeding (above the wound, not over it), tighten until bleeding stops, write the time on the tourniquet with a marker, and do not remove it in the field. Junctional hemorrhage (groin, axilla, neck) gets direct pressure + hemostatic gauze + pressure dressing. Never probe a penetrating wound or remove an impaled object; stabilize and transport.
â¶How do I recognize and treat shock in a trauma patient?
Shock is tissue hypoperfusion: cool skin, weak pulse, altered mental status (anxiety, confusion), tachycardia, and low blood pressure (late sign). In trauma, hemorrhagic shock is most common. Classes: Class I (0â15% blood volume loss)âminimal signs; Class II (15â30%)âtachycardia, mild BP drop; Class III (30â40%)âmarked tachycardia, hypotension, altered mental status; Class IV (>40%)âsevere hypotension, unconsciousness, moribund. Treatment: stop the bleeding (tourniquet, pressure), elevate legs, keep warm (warm blanket, avoid hypothermia), establish large-bore IV (two lines), begin fluid resuscitation (warm normal saline or blood products if available), and rapid transport to a trauma center. Do not delay transport waiting for perfect IV access; en route is fine.
â¶What is the difference between tension pneumothorax and simple pneumothorax and how do I treat each?
Simple pneumothorax: air in the pleural space, unilateral breath sounds diminished, tachypnea, mild hypoxia, stable vitals. Treat with oxygen and observation; most heal on their own. Tension pneumothorax: air continues to accumulate, compressing the heart and great vessels, causing hypotension, jugular venous distension (JVD), tracheal deviation, unilateral breath sounds. This is a life threat. Treat with needle decompression: 14-gauge needle over the 2nd intercostal space midclavicular line, listen for air rush, then place a chest tube. Do not wait for a chest X-ray; needle decompression first, then imaging.
â¶How do I immobilize a fracture in the field?
Goal: prevent further tissue damage and reduce pain. Techniques: (1) SAM Splint or cardboard splint for arm or leg fractures; mold it to the limb and secure with elastic wrap. (2) Pillow splint for ankle/foot: wrap and tie a pillow around the injury. (3) Sling and swathe for shoulderâuse a triangular bandage or sling for the arm, secure the elbow to the body. (4) Pelvic binder for pelvic fracture: wrap a belt or specialized binder around the hips to stabilize and reduce bleeding into the pelvis. (5) Traction for femur fractures if trainedâapply gentle traction in line with the limb, then splint. Never force a limb straight; splint in the position found. Recheck distal pulse, color, warmth, and sensation after splinting to ensure you did not cut off circulation.
â¶What is the FAST exam and when do I use it?
FAST (Focused Assessment with Sonography for Trauma) is a bedside ultrasound that takes 2â3 minutes and looks for free fluid (blood) in the abdomen and around the heart. Views: (1) Pericardialâcheck for fluid around the heart (tamponade). (2) Right upper quadrantâMorrison's pouch, check for free fluid in the liver area. (3) Left upper quadrantâsplenorenal interface. (4) Suprapubicâlook for fluid in the pelvis. If positive for free fluid in a hemodynamically unstable trauma patient, that patient likely needs emergency surgery. FAST is not perfect (operator-dependent, missed injuries possible) but is fast and sensitive for bleeding. Used in trauma centers and paramedic services with ultrasound capability.
â¶What are the signs of an expanding hematoma or internal bleeding and when do I suspect it?
Signs: expanding bruising or swelling at an injury site, abdominal distension with bruising (seat belt sign = abdominal injury), flank bruising (retroperitoneal bleed), hemoptysis (lung contusion), hematuria (genitourinary injury), rectal bleeding, vomiting blood. The patient is in shock (tachycardia, hypotension, cool skin, altered mental status) but the source of bleeding is not visible. Suspect internal bleeding in any trauma patient with shock and no external bleeding. Treatment: do not delay transport, start IV fluids and blood products (trauma centers have massive transfusion protocols), keep NPO, and prepare for emergency surgery or interventional radiology. Do not assume the bleeding will stop on its own; internal bleeding in the chest, abdomen, or retroperitoneum can kill quickly.
