Systematic approach to trauma assessment with musculoskeletal focus including life-threatening hemorrhage control, pelvic and long bone fracture assessment, and integration with ATLS principles.
The trauma primary survey follows ATLS principles with CABCDE approach. Examiners expect you to understand how musculoskeletal injuries fit within the primary survey, particularly life-threatening hemorrhage from pelvic and long bone fractures, and spinal immobilization.
High-Yield Exam Summary
C-ABCDE:
Key Principle: Treat life-threatening problems as you find them before moving to the next step.
External Hemorrhage:
When to Apply Tourniquet:
Technique:
C-Spine Immobilization Required If:
Maintain Manual In-Line Stabilization during any airway intervention
Can Patient Talk?
Look for Obstruction:
Interventions:
Inspect:
Palpate:
Percuss:
Auscultate:
Tension Pneumothorax:
Massive Hemothorax:
Open Pneumothorax:
Blood Loss by Site:
| Site | Estimated Blood Loss |
|---|---|
| Pelvis | 2-4 liters (potentially exsanguinating) |
| Femur | 1-2 liters per side |
| Tibia | 500mL-1L |
| Humerus | 250-500mL |
| Chest (hemothorax) | 2-3 liters |
| Abdomen | Variable (massive possible) |
"Blood on the Floor and Four More": Major hemorrhage sources:
If hypotensive: Look for these sources!
Identify potentially unstable pelvic fracture
Pain, instability, or crepitus with gentle compression
Potentially unstable pelvic fracture - apply pelvic binder
Ability to detect true positives
Ability to exclude false positives
Indications:
Correct Position:
Types:
Rapid Assessment:
Femur Fractures:
Open Fractures:
AVPU Scale:
GCS (Glasgow Coma Scale):
Pupils:
Rapid Assessment:
Neurogenic Shock:
Spinal Shock:
Log Roll:
Environmental Control:
Trauma Triad of Death:
These are self-perpetuating and lead to physiological exhaustion. Prevention is key - damage control surgery principles.
After Primary Survey and Resuscitation:
AMPLE History:
Each Limb:
Document:
High Mortality Injury:
Management:
"32-year-old motorcyclist brought to ED after high-speed collision. GCS 14, heart rate 120, blood pressure 85/60."
High-Yield Exam Summary