Trauma Tree

Select a workflow to begin.

Primary Workflow

Trauma Code Dashboard

Full ATLS-based trauma activation workflow. Systematic assessment from triage through primary survey (xABCDE), secondary survey, imaging, disposition, and consulting services.

Admission Pathway

Trauma Service Admission Decision Tree

Determine the appropriate admitting service based on mechanism, injury pattern, and hospital protocols.

Transfer Pathway

Transfer to Higher Level Trauma Center

MTAC regional transfer criteria for adult and pediatric trauma patients. Determine if patient injuries exceed facility capabilities and require transfer.

Trauma/ED Hospitalization Decision Tree

Determine the appropriate admitting service based on mechanism, injury pattern, and hospital protocols. Based on the Trauma/ED Hospitalization Decision Tree (2-15-2024).

STEP 1 What is the primary reason this patient needs hospitalization?

Select the option that best describes why this injured patient requires admission. This determines the admitting service.

Transfer to Higher Level Trauma Center

MTAC Regional Transfer Criteria and Management Guidelines. Does not replace clinical judgement — when unsure, call for consult.

STEP 1 Patient population

Triage

Document mechanism of injury, initial vitals, and prehospital triage criteria. This section captures how and why the patient arrived and identifies injury severity to guide your workup.

ATLS 10-Second Assessment

Introduce yourself. Ask the patient their name and what happened. An appropriate verbal response confirms: airway is patent (can speak clearly), breathing is not severely compromised (generating air movement), and consciousness is not markedly decreased (alert enough to describe events). Failure to respond: immediate assessment of A, B, C, and D.

STEP 1 Mechanism of Injury
STEP 2 Patient Demographics & Initial Vitals
yr
lbs
bpm
mmHg
/min
%
°F
/15
Field Triage Criteria (ATLS 11th Ed / 2021 National Guidelines) — RED criteria indicate highest-level trauma center transport. YELLOW criteria indicate preferential transport to a trauma center. For patients already at your facility, these criteria help identify injury severity and flag patients who may need transfer.
RED Physiologic Criteria — Vital Signs & Level of Consciousness

Any positive indicates severe physiologic derangement. Evaluate for transfer to Level I trauma center if injuries exceed facility capability.

RED Anatomic Criteria — Injury Pattern

Any positive indicates significant anatomic injury. Ensure required surgical specialties are available. If not, initiate transfer.

YELLOW Mechanism Criteria — High-Energy Impact

Any positive indicates high-energy mechanism. Maintain high index of suspicion for occult injuries. Full trauma workup indicated.

YELLOW Special Patient & System Considerations

Special populations requiring additional consideration

Primary Survey — xABCDE

ATLS 11th Edition systematic life-threat identification. The "x" addresses eXsanguinating external hemorrhage first. Then assess Airway, Breathing, Circulation, Disability, and Exposure sequentially.

xeXsanguinating External Hemorrhage Control
Rapid visual check for massive external bleeding. Control immediately — takes seconds and is performed while other team members prepare airway assessment. (ATLS 11th Ed, Ch 2-3)
  • Visual sweep for massive external bleeding
    Inspect patient, clothing, stretcher for pooling blood or arterial spurting
  • Direct pressure / wound packing applied
    Gauze dressing over bleeding site, pack deep wounds
  • Tourniquet applied if extremity hemorrhage uncontrolled
    2-3 inches proximal to wound, on skin not clothing, not over joint. Tighten until distal pulse absent. Record time.
  • Scalp hemorrhage controlled
    Direct pressure, sutures, or clips. Monitor even after controlled.
AAirway with C-Spine Protection
Assess airway patency while maintaining cervical spine immobilization.
  • C-spine immobilization in place
    Maintain inline stabilization during all airway maneuvers
  • Patient speaking / airway patent
    Vocalization confirms air movement through vocal cords
  • Inspect oropharynx — clear debris/blood
    Suction, remove foreign bodies, jaw thrust if needed
  • Signs of obstruction assessed
    Stridor, hoarseness, subcutaneous emphysema, facial/neck trauma
BBreathing & Ventilation
Assess chest wall movement, auscultate bilaterally, identify life-threatening thoracic injuries.
  • Chest wall integrity assessed
    Look for flail segments, open wounds, paradoxical movement
  • Bilateral breath sounds confirmed
    Auscultate apex and base bilaterally
  • Tracheal position midline
    Deviation suggests tension pneumothorax
  • Jugular venous distension checked
    JVD with hypotension: consider tension pneumo or tamponade
CCirculation & Hemorrhage Control
Assess perfusion, control external hemorrhage, evaluate for shock.
  • External hemorrhage controlled
    Direct pressure, tourniquet if extremity, wound packing
  • Pulse quality & rate assessed
    Weak/thready pulse suggests significant blood loss
  • Skin color/temperature/capillary refill
    Cool, pale, diaphoretic skin → hemorrhagic shock
  • Two large-bore IVs established
    Minimum 18G, antecubital preferred. Draw labs with access.
Shock Index (auto-calculated from vitals) ATLS 11th Ed, Ch 6
Enter HR and Systolic BP on the Triage tab to calculate.
ABC Score — MTP Activation Trigger ATLS 11th Ed, Ch 6/22
Auto-calculated from vitals, FAST, and MOI. Score ≥2 = consider MTP.
Hemorrhage Classification (clinical estimate)
DDisability — Neurologic Status
Rapid neurologic assessment: GCS, pupil response, lateralizing signs.
EExposure & Environment
Fully expose patient. Log roll and inspect posterior. Prevent hypothermia.
  • All clothing removed
    Complete exposure for thorough examination
  • Log roll — posterior inspection complete
    Inspect spine, flanks, buttocks, posterior thighs
  • Warming measures applied
    Warm blankets, warm IV fluids, warm environment
  • All injuries cataloged
    Document all identified injuries from head-to-toe

Secondary Survey — Head to Toe

Complete head-to-toe examination. Only begin after primary survey is complete and life threats addressed. AMPLE history and focused physical exam.

AMPLE AMPLE History
EXAM Regional Examination — Click to flag findings

Labs & EKG

Enter pertinent lab results. Abnormal values auto-trigger alerts and repeat reminders.

BASIC PANELS CBC / BMP / Lactate / Blood Gas
g/dL
%
K/µL
K/µL
mEq/L
mEq/L
mg/dL
mg/dL
mg/dL
mmol/L
pH
mEq/L
COAG Coagulation ▸
CARDIAC Cardiac / EKG ▸
URINE Urinalysis / Pregnancy / Tox ▸
BLOOD BANK Type & Screen / Transfusion ▸
OTHER Lipase / Other ▸

Imaging Protocol

Recommended imaging based on mechanism, findings, and clinical concern. Adjust based on institutional protocols and patient stability.

IMMEDIATE Trauma Series
Chest X-ray (AP portable)
Pneumothorax, hemothorax, mediastinal widening, rib fractures
▼
Pelvis X-ray (AP)
Pelvic fractures — source of significant hemorrhage
▼
FAST / eFAST Exam
RUQ, LUQ, pelvis, pericardium — evaluate free fluid
▼
CT & ADVANCED CT Imaging & Additional Studies
CT Head (non-contrast)
GCS <15, LOC, focal neuro deficit, skull fracture
▼
CT C-Spine
Midline tenderness, neuro deficit, distracting injury, altered mental status
▼
CT Chest (IV contrast)
Abnormal CXR, significant mechanism, thoracic aortic injury concern
▼
CT Abdomen / Pelvis (IV contrast)
Positive FAST, abdominal tenderness, pelvic fracture, seatbelt sign
▼
CT Angiography
Expanding hematoma, hard vascular signs, proximity injury
▼
CT Face
Facial fractures, significant facial trauma, orbital injury
▼
CTA Neck (BCVI screening)
C-spine fracture, Le Fort, Horner's, neuro deficit not explained by CT
▼
Extremity X-rays
Deformity, point tenderness, swelling, crepitus
▼
Other Imaging
T/L spine, retrograde urethrogram, etc.
▼

Disposition Decision

Based on assessment findings, determine patient disposition: discharge, admit, or transfer.

ASSESSMENT Key Disposition Factors

For patients with ≥2 rib fractures or sternal fracture. Per CaroMont Rib Fracture Admission Protocol.

Risk Factors: Pain ≥8, O₂ >2L NC, Age ≥65.
Escalation rule: Regardless of FVC value, 2+ risk factors → ICU. Select the FVC range below, then toggle applicable risk factors — the disposition will auto-adjust if 2+ are present.

Consulting Services

Click a service to initiate a consult. Green indicates the service is available on-call. Red indicates the service is not available — no consult actions are possible for unavailable services.

CONSULTS Initiate Consult
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Clinical Knowledge Base

31 clinical topics synthesized from ATLS 11th Edition, institutional algorithms, MTAC transfer guidelines, and hospital-specific protocols. Search or browse by category.

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Patient Summary

Comprehensive summary of all findings, imaging, labs, consults, and plan. Use "Copy Summary" to export as plain text for your EMR.

Hospital Configuration

Set up your facility's trauma level, available services, and specialist roster. This configuration customizes all decision trees and recommendations.

REQUIRED Trauma Center Designation
ROSTER Specialist On-Call Configuration

Click each service to cycle: Available Day + Night → Day Only → Not Available. Confirm daily.

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CAPABILITIES Available Services & Resources
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