Primary Survey Complete
Patient stabilized, begin secondary survey
All Pathways
Trauma SurgeryDiagnostic
Trauma Secondary Survey (ATLS)
Trauma Secondary Survey (ATLS): Primary Survey Complete → AMPLE History → Mechanism Details → Head Examination → Neck Examination.
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action AMPLE History
Focused trauma history
- A - Allergies
- M - Medications (including anticoagulants)
- P - Past medical/surgical history, Pregnancy
- L - Last meal (aspiration risk for surgery)
- E - Events/Environment (mechanism of injury)
03Action Mechanism Details
Injury pattern prediction
- MVC: Speed, restraints, ejection, rollover
- Pedestrian vs vehicle: Speed, impact location
- Fall: Height, surface, landing position
- Assault: Weapon type, number of blows
- Penetrating: Weapon, estimated depth
- Burns: Agent, duration, enclosed space
04Action Head Examination
Scalp, skull, face
- Scalp lacerations, hematomas (palpate for fractures)
- Skull: Battle's sign, raccoon eyes
- Eyes: Pupils, visual acuity, EOM, foreign body
- Ears: Hemotympanum, CSF otorrhea
- Nose: Deformity, septal hematoma, CSF rhinorrhea
- Face: Stability, malocclusion, crepitus
- Mouth: Teeth, tongue, bleeding
05Action Neck Examination
With C-spine precautions
- Maintain C-spine immobilization
- Tracheal deviation
- JVD
- Carotid pulses
- Subcutaneous emphysema
- Posterior midline tenderness
- Step-offs
06Action Chest Examination
Thoracic injuries
- Inspection: Contusions, deformity, paradoxical motion
- Palpation: Crepitus, rib tenderness, sternal tenderness
- Auscultation: Breath sounds, heart sounds
- Percussion: Dullness (hemothorax), hyperresonance (pneumothorax)
07Action Abdominal Examination
Serial exams important
- Inspection: Distension, ecchymosis (Grey Turner, Cullen)
- Auscultation: Bowel sounds (often absent acutely)
- Palpation: Tenderness, guarding, rigidity
- Seatbelt sign: Associated hollow viscus injury
- May be unreliable if head injury, intoxication, distracting injury
08Action Pelvis Examination
Single compression only
- DO NOT repeatedly rock pelvis
- Single gentle AP and lateral compression
- Note instability
- Blood at urethral meatus
- Scrotal/perineal hematoma
- Rectal exam: Tone, blood, prostate position
09Action Extremity Examination
All four limbs
- Inspection: Deformity, swelling, wounds
- Palpation: Tenderness, crepitus
- ROM: If spine cleared
- Pulses: Radial, DP, PT
- Motor/sensory: Document before analgesia
- Compartment assessment
10Action Neurological Examination
Detailed assessment
- GCS (detailed breakdown)
- Cranial nerves
- Motor: Strength all extremities
- Sensory: Dermatomes, sacral sparing
- Reflexes: DTRs, Babinski
- Rectal tone (spinal cord injury)
11Action Log Roll - Posterior Exam
Maintain C-spine alignment
- Minimum 4 people
- Leader at head maintains alignment
- Roll as unit
- Inspect: Back, flanks, buttocks
- Palpate: Spine for tenderness, step-offs
- Rectal exam if not done
- Roll back as unit
12Action Documentation & Adjuncts
Complete assessment
- Document all findings
- Order additional imaging based on exam
- Tetanus prophylaxis
- Antibiotics for open wounds/fractures
- Splinting, wound care
- Plan tertiary survey in 24h
13Outcome Secondary Survey Complete
All injuries identified, plan definitive care
Guideline Source
ATLS 11th Edition - Secondary Survey
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Requires primary survey completion first
- May be interrupted for primary survey issues
- Some injuries present delayed
- Repeated exams often necessary
Applicable Regions
USEUGlobal
Version 1Next review: 2029-07-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Trauma Secondary Survey (ATLS)?
The Trauma Secondary Survey (ATLS) is a diagnostic clinical algorithm for Trauma Surgery. It provides a structured decision tree to guide clinical decision-making, based on ATLS 11th Edition - Secondary Survey.
What guideline is the Trauma Secondary Survey (ATLS) based on?
This algorithm is based on ATLS 11th Edition - Secondary Survey (DOI: N/A - ACS Educational Program).
What are the limitations of the Trauma Secondary Survey (ATLS)?
Known limitations include: Requires primary survey completion first; May be interrupted for primary survey issues; Some injuries present delayed; Repeated exams often necessary. Individual patient factors may require deviation from these recommendations.
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