Synopsis
Find and treat immediately lethal injuries, coordinate haemorrhage control and imaging, and prevent secondary injury during definitive-care transfer.
- Control catastrophic haemorrhage at the start while the team assesses airway, breathing and circulation in parallel.
- A normal initial haemoglobin does not exclude substantial acute blood loss; use physiology, mechanism and repeated measurements.
- In hospital, active traumatic bleeding requires blood-product resuscitation rather than repeated crystalloid loading.
Investigation priorities
Assess perfusion and follow the response to haemorrhage treatment.
Management branches
A rider has pelvic pain, cool peripheries, heart rate 132/min and systolic pressure 78 mmHg after a high-energy collision. There is no major external bleeding.
- Activate the trauma and major-haemorrhage responses, support oxygenation and obtain large-bore access while checking for an immediately treatable thoracic cause.
- Apply a purpose-made pelvic binder at the greater trochanters without repeatedly springing the pelvis. Immobilisation reduces movement; it does not establish that all bleeding is controlled.
Key medicines
Tranexamic acid for significant traumatic bleedingGive 1 g IV over 10 minutes as soon as possible within 3 hours of injury, followed by 1 g IV over 8 hours, using the adult major-haemorrhage regimen.Do not routinely start after 3 hours unless hyperfibrinolysis is demonstrated. Record earlier doses and avoid rapid injection. Severe renal impairment or prior thrombosis requires specialist assessment of the applicable product and clinical circumstances.
Blood components in active haemorrhageActivate the adult major-haemorrhage protocol; NICE recommends an initial plasma:red-cell ratio of 1:1, moving to laboratory-guided component replacement as soon as possible.Use correct emergency identification, warming and repeated assessment of ionised calcium, coagulation and temperature. Products cannot replace anatomical haemorrhage control; avoid automatic crystalloid substitution in hospital active bleeding.