Primary survey (ABCDE)

Airway & C-Spine - Don't Choke!

• Assess Patency: Ask name (vocalization). Listen for stridor (obstruction), gurgling (fluid), or hoarseness (laryngeal injury). Inspect for foreign bodies, edema, or facial/neck trauma.
• C-Spine Protection: Crucial! Assume C-spine injury in any significant blunt trauma. Maintain manual in-line stabilization (MILS) until a rigid collar is placed and injury is radiologically cleared.

⭐ GCS ≤ 8? Intubate! A Glasgow Coma Scale score of 8 or less is a strong indication for definitive airway placement to protect against aspiration and ensure adequate ventilation.

Breathing & Ventilation - In and Out

• Assess: Expose chest. Check for symmetrical rise, paradoxical motion (flail chest), crepitus, and penetrating wounds. Auscultate for bilateral air entry.
• Critical Diagnoses & Actions:
  • Tension Pneumothorax: Needle decompression (14-16G) then chest tube.
  • Open Pneumothorax: Three-sided occlusive dressing.
  • Massive Hemothorax: Chest tube insertion; anticipate thoracotomy if >1500mL initial output.
• Oxygenation: Administer high-flow O₂ (15L/min) via non-rebreather mask.

⭐ Needle decompression landmark is the 5th ICS, anterior axillary line (AAL), superior to the rib below.

Circulation & Hemorrhage - The Red Sea

• Assess: Check pulse (rate, quality), skin color, temp, capillary refill (<2s). Hypotension is a late sign.
• Control Bleeding:
  • Direct pressure is first-line.
  • Tourniquet for exsanguinating limb hemorrhage.
  • Pelvic binder for suspected pelvic fractures.
• IV Access: Establish 2 large-bore (≥16G) IV lines.
• Resuscitation: Start with 1L warm crystalloid (Lactated Ringer's). If transient/no response, initiate massive transfusion protocol.

⭐ Permissive Hypotension: In penetrating trauma without CNS injury, target a lower SBP (80-90 mmHg) until bleeding is controlled to avoid dislodging clots.

Disability (Neuro) - Who's Home?

• Goal: Rapidly assess neurological function & identify life-threatening CNS injury.
• Glasgow Coma Scale (GCS): Assesses level of consciousness.
  • Eyes (4): Spontaneous, To voice, To pain, None
  • Verbal (5): Oriented, Confused, Words, Sounds, None
  • Motor (6): Obeys, Localizes, Withdraws, Flexion, Extension, None
• Pupils: Check size, equality, and reactivity. A blown pupil can indicate uncal herniation.
• AVPU: Quick alternative 📌 Alert, Verbal, Pain, Unresponsive.

⭐ GCS ≤ 8 is a critical threshold, often considered an indication for definitive airway management (intubation).

Exposure & Environment - Trauma Undressed

• Goal: Completely undress the patient to identify all injuries while actively preventing hypothermia.
• Procedure:
  • Remove all clothing, cutting if necessary to avoid unnecessary movement.
  • Log roll the patient, maintaining spinal immobilization, to inspect the back, spine, and posterior surfaces.
• Hypothermia Prevention:
  • Cover with warm blankets immediately after assessment.
  • Use warmed IV fluids.
  • Increase ambient room temperature.

⭐ Hypothermia is a key part of the lethal Trauma Triad of Death (along with acidosis and coagulopathy), worsening outcomes by impairing clotting.

High‑Yield Points - ⚡ Biggest Takeaways

• The ABCDE sequence is a strict hierarchy; address life-threats in order before proceeding.
• Airway management must always include cervical spine protection.
• For Breathing, immediately decompress a suspected tension pneumothorax based on clinical signs, not imaging.
• For Circulation, stop major external bleeding first, then establish two large-bore IVs.
• Disability is a rapid neuro exam using the Glasgow Coma Scale (GCS).
• Expose the patient to prevent missed injuries, but prevent hypothermia.