Primary survey ‘ABC’

Initial treatment should follow standard advanced trauma life support (ATLS) algorithms.
• Airway—cervical spine stability needs to be maintained. Open and maintain the
airway; intubation may be required. Upper-airway oedema may cause obstruction;
circumferential full-thickness burns of the neck may also cause extrinsic compression.
• Breathing—100% O2 is given. Life-threatening injuries such as tension pneumothorax,
massive haemothorax and massive flail chest can result from the initial incident,
e.g. the force of the blast, or from injuries sustained while escaping the scene,
such as jumping from a height. Circumferential full-thickness chest burns may limit
ventilatory movements.
• Circulation—treat any life-threatening haemorrhage. Obtain adequate intravenous
access.
Take an ‘AMPLE’ history: The history is very important:
• Allergies Cause—determines likely depth of the injury.
• Medication Place—particularly if in an enclosed space,
• Past medical history to ascertain risk of smoke inhalation.
• Last meal Enquire about any first aid given. There may
• Event. be associated injuries from the initial event or
from trying to escape.