Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VIII: Multiple Injuries

Advanced Trauma Life Support

United States Department of Defense

Primary Survey. During the primary survey, life-threatening conditions are identified and their simultaneous management is begun.

1. A - Airway maintenance with cervical spine (C-spine) control.

2. B - Breathing.

3. C - Circulation with hemorrhage control.

4. D - Disability; neurologic status.

5. E - Expose; completely undress the patient.

Resuscitation Phase. During this phase, the oxygenation and ventilation are reassessed. Shock management is initiated and hemorrhage control is reevaluated. A urinary catheter and nasogastric tube may also be inserted during this phase if their use is not contraindicated.

Secondary Survey. The secondary survey does not begin until the primary survey (ABCDE) has been completed and the resuscitation phase (management of other life-threatening conditions) has begun. The secondary survey is a head-to-toe evaluation of the casualty. Each section of the body is examined in an organized fashion, utilizing look, listen, and feel techniques. Chest and C-spine X-rays may be obtained during this section, but only after the patient is stabilized.

Definitive Care Phase. In this phase, the patient's less-life-threatening injuries are managed (setting of fractures, stabilization, wound debridement, and transfer).

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Operational Medicine 2001

Health Care in Military Settings

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