Peggers Super Summary: Principles of ATLS

Introduction: b. Palpation
Overview: i. Trachea
ii. Apex
1. Primary Survey c. Percussion
a. Airway and C-Spine d. Ascultation
b. Breathing e. RULE OUT: ATOM FC
c. Circulation i. Airway Obstruction
d. Disability ii. Tension Pneumothorax
e. Exposure iii. Open Pneumothorax
2. Adjuncts to Primary Survey iv. Massive Haemothorax
a. Monitoring v. Flail Chest
b. Catheters vi. Cardiac Tamponade
c. X-Rays and Diagnostic studies (Muffled HS, increase JVP,
3. Secondary Survey Hypotension- Becks Triad)
a. History 3. Circulation and Haemorrhage Control
b. Head and Skull a. Inspection and Observations
c. Maxillofacial and Intra-oral i. Level of consciousness
d. Neck ii. Skin colour
e. Chest iii. HR, BP, Capillary refill,
f. Abdomen (including back) b. Palpate
g. Perineum/Rectum/Vagina c. Auscultate
h. Musculoskeletal 4. Disability
i. Neurological a. Pupils
4. Adjuncts to Secondary Survey b. AVPU/GCS
a. CT c. BMs
b. Contrast X rays 5. Exposure
c. Extremity X Rays a. Control Temperature
d. Endoscopy and US b. Assess for other injuries

Adjuncts to Primary Survey:

Primary Survey: 1. ECG
2. Catheters
1. Airway and C-Spine a. Urinary CI:
a. Assume C spine injury in: i. Blood at meatus
i. Multitrauma ii. Perineal Ecchymosis
ii. Decrease consciousness iii. Scrotal Blood
iii. Blunt injury above clavicle. iv. High riding Prostate
b. Immbalise spine with hands until v. Pelvic Fracture
blocks can be administered 2 b. Gastric
person technique 3. Monitoring
c. 15L of o2 via Re-breath bag and a. Observations
mask b. ABG
2. Breathing c. End Tidal CO2
a. Inspection and Monitoring 4. X rays
i. RR and Sats a. C Spine
ii. Colour of Patient b. CXR
iii. Accessory Muscles c. Pelvic
iv. Symmetrical Breathing d. Diagnostic Peritoneal Lavage
e. FAST Scan
 Peggers Super Summary: Principles of ATLS
Secondary Survey: 8. MSK 3 S Stop bleeding Splint and
Stabilise Pelvis
1. History a. Reduce
a. A: Allergies b. Splint
b. M: Medications c. Check NV status
c. P: PMH d. Compartment Syndrome
d. L: Last ate e. Pelvic space 2cm increase = 1.5L
e. E: Environment increase in volume
f. T: Tetanus f. 5cm increase = 5 L increase in
2. Head and Skull volume
a. Visual Acuity 9. Neurological
b. Pupillary Size a. Spinal Shock
c. Penetrating trauma i. Flaccidity, decrease reflexes
d. Contact lenses and full bladder
e. Battles Sign/Pander Sign b. Neurogenic Shock
f. Haemotympanium i. Hypotensive, Bradycardic,
3. Maxillofacial and Intra-oral Paradoxical Breathing
a. Crepitus c. Focal Neurology
b. Deformity i. Tone
c. Mal-alignment ii. Power
d. Respiratory Problems iii. Reflexes
e. Hypermobility of upper/lower jaw iv. Sensation
4. Neck: v. Plantars
a. Image anyone with
i. Age >65yrs
ii. Dangerous Mechanism Adjuncts to the Secondary Survey
1. Fall >1meter
2. Diving/Axial Load to 1. CT
Head a. CI:
3. MVC > 60mph i. Rigid Abdomen/Guarding
4. Recreational Vehicles ii. Non Responder in Fluid
5. Bicycle resuscitation
iii. Limb Paresthesia iii. Unstable Patient
5. Chest iv. Positive DPL or FAST
a. Inspect v. Penetrating abdominal
b. Palpate trauma
c. Percuss vi. Free air on CXR
d. Auscultate 2. Contrast X rays
6. Abdomen (Pregnancy in Females) a. Damage to hollow viscus or major
a. Inspect BV
b. Palpate 3. Extremity X rays
c. Percuss a. AP and Lateral
d. Auscultate b. Pre and Post Reduction
7. Perineum 4. Endoscopy
a. Inspection for bleeding/bruising 5. Ultrasonography
b. High Riding Prostate