Primary Survey
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Airway: Establish and ensure a clear airway.
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Breathing: Ventilate with 100% O2 and check for breathing compromise.
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Circulation: Apply pressure to sites of external bleeding, place two large-bore IV lines, assess blood volume status, and begin fluid resuscitation if signs of hypovolemia.
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Disability: Document functional status and perform a brief neurologic examination.
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Exposure: Completely disrobe the patient and logroll to inspect the back.
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Secondary survey:
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Perform a head-to-toe examination to search for other injuries and set further priorities.
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May include trauma series imaging, focused assessment with sonography in trauma (FAST), Foley catheter or gastric tube placement, splinting of unstable fractures/dislocations, tetanus prophylaxis, surgical consultation, and medications.
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The first step in patient management is performing the primary survey, the goal of which is to identify and treat conditions that constitute an immediate threat to life. The ATLS course refers to the primary survey as assessment of the “ABCs” (Airway with cervical spine protection, Breathing, and Circulation). The timing of emergent intubation in the hypovolemic patient remains controversial because of the risk of further compromising cardiac function. Although the concepts within the 
primary survey are presented in a sequential fashion, in reality they are pursued simultaneously in coordinated team resuscitation. Life-threatening injuries must be identified (Table 7-1) and treated before progressing to the secondary survey.
To identify and treat conditions that constitute an immediate threat to life.
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Airway with cervical spine protection, Breathing, and Circulation), although at times restoring Circulatory volume may proceed active Airway intervention;
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All patients with blunt injury should be assumed to have unstable cervical spine injuries until proven otherwise; one must maintain cervical spine precautions and in-line stabilization.
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Patients with ongoing hemodynamic instability, whether “nonresponders” or “transient responders,” require prompt intervention; one must consider the dominant causes of acute shock, i.e., hemorrhagic, cardiogenic, and neurogenic shock.
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Patients with trauma-induced coagulopathy (TIC) are at risk for massive transfusion and need to be identified early.
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Indications for immediate operative intervention for penetrating cervical injury include hemodynamic instability and significant external arterial hemorrhage; the management algorithm for hemodynamically stable patients is based on the presenting symptoms and anatomic location of injury, with the neck being divided into three distinct zones.
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The gold standard for determining if there is a blunt descending aortic injury is computed tomography angiography (CTA) scanning; indications are primarily based on injury mechanism.
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The abdomen is a diagnostic black box. Physical examination and FAST ultrasound can identify patients requiring emergent laparotomy. Computed tomography (CT) scanning is the mainstay of evaluation in the remaining patients to more precisely identify the site and magnitude of injury.
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Manifestation of the “bloody vicious cycle” (the lethal combination of coagulopathy, hypothermia, and metabolic acidosis) is the most common indication for damage control surgery. The primary objectives of damage control laparotomy are to control bleeding and limit gastrointestinal spillage.
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Blunt injuries to the carotid and vertebral arteries are usually managed with systemic antithrombotic therapy.
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The abdominal compartment syndrome may be primary (i.e., due to the injury of abdominal organs, bleeding, and packing) or secondary (i.e., due to reperfusion visceral edema, retroperitoneal edema, and ascites).