Snapshot A 30-year-old man presents to the ED after being hit by a large truck. He is brought on a backboard with a cervical collar. Oropharyngeal airway mask and one peripheral IV with fluid running are in place. Multiple lacerations on his scalp and thighs are wrapped in dressings. Blood pressure is 80/40 mmHg, pulse is 140/min, respirations are 40/min, and SaO 2 is 92% on RA. introduction Most common method of initial trauma assessment in the United States is based on Advanced Trauma Life Support (ATLS) course from American College of Surgeons goal is to treat greatest threats to life immediately lack of definitive diagnosis and detailed history should not impede therapy Presentation Trauma patient can present to the ED from multiple different scenarios blunt trauma, motor vehicle collisions, falls are most common penetrating trauma (guns/knives/others) environmental injuries burn cold electric smoke bite Precipitating factors to trauma must also be considered: 6 S's Seizure, Syncope, Sugar (hypoglycemia), Suicide, Sleep (abnormality), Sauce (alcohol) Diagnosis Primary survey (often concurrent with resuscitation): ABCDE Airway signs of obstruction: agitation, confusion, respiratory distress, failure to speak, cyanosis Breathing observe for altered mental status, chest movement, nasal flaring listen for signs of obstruction (stridor, asymmetry, air escape) feel for trachael shift, crepitus, flail segments, subcutaneous emphysema objective signs: rate, oximetry, ABG, A-a gradient Circulation look for evidence of shock login to view 1 more bullet early signs: tachycardia, tachypnea, narrow pulse pressure, reduced capillary refill, cool extremities late signs: hypotension, altered mental status, reduced urine output Disability level of consciousness assessed by Glasgow Coma Scale (GCS) login to view 7 more bullets Exposure/Environment undress patient completely and assess entire body for injury logroll to examine back digital rectal exam Management Resuscitation done at the time as primary survey, with focus on ABC Airway temporizing measures login to view 4 more bullets definitive measures login to view 11 more bullets Breathing in order of increasing FiO 2: nasal cannula, face mask, non-rebreather, CPAP/BiPAP bag-valve mask and CPAP/BiPAP used to supplement inadequate ventilation Circulation monitor vital signs, ECG, oxygen saturation if bleeding externally, apply direct pressure and elevate extremities if possible login to view 3 more bullets resuscitation login to view 5 more bullets Advance Cardiac Life Support (ACLS) algorithm as necessary for arrhythmias Foley catheter and NG tube if indicated login to view 7 more bullets proceed to detailed secondary survey and definitive care