Synopsis
Run a disciplined trauma-team assessment that identifies and treats immediate threats, coordinates parallel action, and prevents important injuries being lost during handover or deterioration.
- Use CABCDE when catastrophic external bleeding is evident; otherwise follow ABCDE while another team member obtains monitoring, access and a concise ATMIST handover.
- Call out each finding, intervention and response. A named leader maintains the overview while airway, procedure, nursing, imaging and scribing roles work in parallel.
- Do not wait for the end of the primary survey to decompress a tension pneumothorax, control major bleeding, apply a correctly positioned pelvic binder or initiate blood-component resuscitation.
Key red flags
Absent or threatened airway, severe respiratory distress, shock, reduced consciousness or active external bleeding requires immediate parallel resuscitation rather than completion of history taking.
Investigation priorities
Detect deterioration during assessment and intervention.
Map injuries rapidly across body regions.
Management branches
Any patient with suspected major trauma or abnormal physiology.
- Control catastrophic external haemorrhage, assess airway with spinal protection, give oxygen when critically ill and call anaesthetic help for a threatened airway.
- Identify and treat breathing threats clinically, attach monitoring, obtain large-bore intravenous or intraosseous access and activate major-haemorrhage support when indicated.
Key medicines
Tranexamic acidFor an adult with active or suspected major bleeding, give 1 g intravenously over 10 minutes followed by 1 g infused over 8 hours, started as soon as possible and within 3 hours of injury.