Trauma Patient Arrival
Initiate primary survey using xABCDE approach
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Trauma SurgeryEmergency
Trauma Primary Survey (xABCDE) - ATLS 11
Trauma Primary Survey (xABCDE) - ATLS 11: Trauma Patient Arrival → [X] Exsanguinating Hemorrhage? → IMMEDIATE Hemorrhage Control → [A] Airway with C-spi...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Decision [X] Exsanguinating Hemorrhage?
Assess for life-threatening external bleeding
- Massive external hemorrhage?
- Arterial bleeding from extremity?
- Traumatic amputation?
- Junctional hemorrhage (neck, axilla, groin)?
- Yes - Control First
03Warning IMMEDIATE Hemorrhage Control
Control bleeding BEFORE airway
- Direct pressure
- Tourniquet for extremity (high and tight)
- Wound packing + pressure for junctional
- Hemostatic agents if available
04Decision [A] Airway with C-spine Protection
Assess airway patency and protect cervical spine
- Is patient talking? (airway patent)
- Look for obstruction (blood, vomitus, teeth)
- Listen for stridor, gurgling
- Maintain manual in-line stabilization
- Apply cervical collar
- Compromised
05Action Secure Airway
Airway compromised - intervene
- Chin lift/jaw thrust (avoid head tilt)
- Suction if needed
- OPA/NPA if tolerated
- Intubate if GCS ≤8 or unable to protect
- Surgical airway if cannot intubate/ventilate
06Decision [B] Breathing & Ventilation
Assess respiratory function
- Expose chest - look for asymmetry
- Count respiratory rate
- Auscultate bilateral breath sounds
- Palpate for crepitus, tracheal deviation
- SpO2 monitoring
- Abnormal
07Warning Life-Threatening Chest Injury
Immediate intervention required
- Tension pneumothorax: Needle decompression → chest tube
- Open pneumothorax: 3-sided occlusive dressing
- Massive hemothorax: Chest tube + prepare for OR
- Flail chest: Consider positive pressure ventilation
08Decision [C] Circulation & Hemorrhage Control
Assess perfusion and control bleeding
- Assess pulse quality, rate, regularity
- Skin color, temperature, capillary refill
- Blood pressure (SBP <90 = Class III/IV shock)
- Identify sources: chest, abdomen, pelvis, long bones, external
- 2 large-bore IV access
- Shock
09Action Hemorrhagic Shock Management
Initiate damage control resuscitation
- Activate MTP if criteria met
- Permissive hypotension (SBP 80-90) until surgical control
- TXA 1g IV if <3 hours from injury
- Warm blood products
- Avoid excessive crystalloid
- Responds
10Action [D] Disability (Neuro Assessment)
Rapid neurological evaluation
- Glasgow Coma Scale (GCS)
- Pupil size and reactivity
- Lateralizing signs
- GCS ≤8: Protect airway, consider TBI
- Check glucose (rule out hypoglycemia)
11Action [E] Exposure & Environment
Complete exam, prevent hypothermia
- Completely undress patient
- Log-roll for posterior exam
- Prevent hypothermia: warm blankets, warm fluids
- Temperature monitoring
- Cover patient after examination
12Action Primary Survey Adjuncts
Monitoring and diagnostics
- ECG monitoring
- Foley catheter (if no contraindication)
- Gastric tube (NG or OG)
- FAST exam or DPL
- Chest and pelvis X-rays
- Labs: Type & Screen, CBC, BMP, Coags, Lactate
13Outcome Proceed to Secondary Survey
Once stabilized, complete head-to-toe evaluation
- Unstable
14Warning Immediate OR / IR
Unstable despite resuscitation
- Damage control surgery
- Interventional radiology for embolization
- REBOA consideration for non-compressible torso hemorrhage
- Path rejoins step 13Shared downstream outcome
- Stable
- Path rejoins step 10Shared downstream outcome
- Normal
- Path rejoins step 08Shared downstream outcome
- Patent
- Path rejoins step 06Shared downstream outcome
- Path rejoins step 04Shared downstream outcome
Guideline Source
ATLS 11th Edition - Advanced Trauma Life Support
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Simplified for adult patients - pediatric modifications may apply
- Does not replace hands-on ATLS training
- Assumes availability of standard trauma resources
- Specific interventions depend on local protocols
Applicable Regions
USEUGlobal
US: ATLS 11 launched July 2025 with xABCDE emphasis
Global: xABCDE now universal language per ACS
Version 1Next review: 2029-07-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Trauma Primary Survey (xABCDE) - ATLS 11?
The Trauma Primary Survey (xABCDE) - ATLS 11 is a emergency clinical algorithm for Trauma Surgery. It provides a structured decision tree to guide clinical decision-making, based on ATLS 11th Edition - Advanced Trauma Life Support.
What guideline is the Trauma Primary Survey (xABCDE) - ATLS 11 based on?
This algorithm is based on ATLS 11th Edition - Advanced Trauma Life Support (DOI: N/A - ACS Educational Program).
What are the limitations of the Trauma Primary Survey (xABCDE) - ATLS 11?
Known limitations include: Simplified for adult patients - pediatric modifications may apply; Does not replace hands-on ATLS training; Assumes availability of standard trauma resources; Specific interventions depend on local protocols. Individual patient factors may require deviation from these recommendations.
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