Catastrophic haemorrhage first, then Airway, Breathing, Circulation, Disability, Exposure
Expansion
cABCDE, treating each problem as it is found before moving on:
- c - catastrophic haemorrhage: direct pressure, tourniquet, haemostatic dressing
- A - Airway with cervical spine protection
- B - Breathing and ventilation
- C - Circulation with haemorrhage control
- D - Disability: AVPU or GCS, pupils, blood glucose
- E - Exposure and environment, preventing hypothermia
Life threatening chest injuries to find in B and C, remembered as ATOM FC: Airway obstruction, Tension pneumothorax, Open pneumothorax, Massive haemothorax, Flail chest, Cardiac tamponade.
The lethal triad of trauma is hypothermia, acidosis and coagulopathy, each worsening the others, which is why damage control surgery and active warming matter as much as operating.
Permissive hypotension is used in penetrating trauma without head injury, aiming for a palpable radial pulse rather than a normal pressure, since raising the pressure dislodges clot.
Blood, not crystalloid, is the resuscitation fluid in major trauma, with tranexamic acid within 3 hours.
The secondary survey is a head to toe examination with an AMPLE history: Allergies, Medications, Past history, Last meal, Events.