If a patient is exsanguinating from a limb, apply a tourniquet before assessing the airway. Mentioning catastrophic haemorrhage control as the first step demonstrates current knowledge.
A — Airway with cervical spine protection
Talk to the patient. A normal voice means a patent airway. Stridor, gurgling, or silence means a problem. Jaw thrust, suction, airway adjuncts, definitive airway if needed. ATLS 11 emphasises selective spinal motion restriction rather than rigid collars for all.
B — Breathing
Inspect, palpate, percuss, auscultate. Look for tension pneumothorax, open pneumothorax, massive haemothorax, flail chest, cardiac tamponade. Tension pneumothorax is a clinical diagnosis — decompress before imaging.
Absent breath sounds with hypotension means tension pneumothorax until proven otherwise. Needle decompression — the answer the examiner wants to hear.
C — Circulation with haemorrhage control
ATLS 11 emphasises damage control resuscitation: permissive hypotension (SBP ~90 in penetrating trauma), balanced transfusion 1:1:1, reduced crystalloid, tranexamic acid within 3 hours. Source: "blood on the floor and four more" — chest, abdomen, pelvis, long bones.
D and E
Disability: AVPU or GCS, pupils, glucose. Agitation often signals hypoxia before neurological injury. Exposure: fully expose, log roll, prevent hypothermia. The primary survey is a cycle. Visual trauma frameworks are in SurgAtlas at surgatlas.com.