Trauma-team primary and secondary surveys — Rapid

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.
Record Glasgow Coma Scale components, pupils, glucose and limb neurology; a falling score is a clinical deterioration, not an imaging result to await.
Expose sufficiently to find posterior, perineal and junctional injury, while using warmed blankets, fluid warmers and active warming to prevent hypothermia.
Begin the secondary survey only after immediate threats have been treated and physiology is stabilising; return to CABCDE whenever observations worsen.
Use whole-body CT for appropriate haemodynamically stable or responding adults with suspected multiple injuries; an unstable non-responder needs haemorrhage control, not a diagnostic tour.
Close every transition with a structured handover, explicit outstanding actions and a planned tertiary survey because resuscitation, transfer and altered consciousness conceal injuries.

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.

A transient response to blood, recurrent hypotension, rising lactate or increasing vasopressor requirement indicates ongoing haemorrhage until a source has been controlled.

Disagreement between apparently minor external injury and abnormal physiology should trigger renewed exposure, ultrasound or imaging review and a search for concealed chest, abdominal, pelvic or long-bone bleeding.

Investigation priorities

First-line continuous monitoringFirst stepFirst line

Detect deterioration during assessment and intervention.

Preferred definitive imaging in stable polytraumaPreferred

Map injuries rapidly across body regions.

Management branches

ImmediateRun and repeat CABCDE

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.
Assess circulation, disability and exposure in parallel, prevent heat loss, splint painful deformity and announce each intervention with the observed response.
Return to the start after every procedure, transfer or deterioration; a completed form never overrides changing physiology.

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.Do not give routinely more than 3 hours after injury unless hyperfibrinolysis is specifically present; reduce maintenance exposure in significant renal impairment and check the current major-haemorrhage protocol.

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