Trauma is the leading cause of death in the Western world for people aged 1–44. Globally, >5.8 million people die annually due to severe trauma. Massive bleeding and trauma-induced coagulopathy remain a major challenge. Key principle: Treat first what kills first.

📊 About

Accounts for ~37% of ED visits
Common causes of trauma death: motor vehicles, homicide, falls
Organised trauma systems significantly improve outcomes
Retention of ATLS principles is essential

📝 Causes

Motor vehicle collisions
Falls, burns, drowning, machinery accidents, electrocution
Assaults with weapons (knives, guns, blunt trauma)
Natural disasters: earthquakes, floods, avalanches, tsunamis
Warfare injuries

🚨 Trauma Team Activation Criteria

SBP < 90 mmHg
RR <10 or >30 /min
GCS < 12 with torso/extremity trauma
Pregnancy >20 weeks with abnormal foetal HR
Proximal amputations, ≥2 long-bone fractures
Airway compromise, spinal cord injury, severe burns (>15% TBSA)
Gunshot or penetrating trauma to chest/abdomen/neck/groin
Falls >6m, ejection from vehicle, pedestrian struck
ED clinician concern (“gut feeling” rule)

👥 Trauma Team

Led by an ED Consultant, the leader coordinates but does not touch the patient. Goal: identify and manage life threats within ~30 minutes.

Team Leader
Anaesthetist + ODP
Primary survey doctor
Nurses (ideally 2)
Procedures doctor
Scribe
IV/bloods nurse
Porter, family liaison

📉 Trimodal Distribution of Deaths

Seconds–minutes: Major CNS or airway/vascular injury (often unsurvivable)
Minutes–hours: Major head/chest/abdominal/pelvic injury, exsanguination (“golden hour”)
Days–weeks: Sepsis, MODS in ICU

Note: Now thought of more as a continuum than rigid phases.

🩺 Primary Survey – CABCDE

C – Catastrophic haemorrhage: control bleeding (direct pressure, tourniquet, haemostatic dressings)
A – Airway + C-spine: suction, airway adjuncts, intubate if GCS <9 or airway threatened; avoid head-tilt if trauma
B – Breathing: oxygen, exclude PTX/HTX, flail chest; use BVM or intubate if hypoventilating
C – Circulation: control haemorrhage, 2x large-bore IV access, crossmatch, balanced resuscitation (early blood & TXA), avoid >1L crystalloid
D – Disability: GCS/AVPU, pupils, check glucose; CT head if concern
E – Exposure/Environment: fully examine, prevent hypothermia

🫁 Immediate Life-Threatening Causes to Exclude (“HOTTT-C”)

Haemorrhage (external or internal)
Obstructed airway
Tension pneumothorax
Tamponade (cardiac)
Thoracic trauma (open PTX, flail chest)
Coma / brain injury

🫀 Indications for Intubation (“4 Ps”)

Poor ventilations / apnoea
Protection of airway from aspiration
Pending obstruction (burns, swelling)
Persisting hypoxia

📸 Trauma Imaging

Unstable: eFAST → theatre
Stable: CT traumogram if suspicion of solid organ/pelvic injury
IR (interventional radiology) considered for pelvic/liver/spleen bleeds

🚑 Pre-Transfer Checks (“SAFE”)

Safe: ABCDE stable in last 5 minutes?
Airway secure? Enough sedation if intubated?
Functioning kit: oxygen, monitoring, ventilator battery
Escort: staff, route cleared, destination informed

🔑 Exam Pearls

Trauma leader = hands off
TXA within 3h of major bleed reduces mortality
Nasopharyngeal airway contraindicated in base of skull fracture
Permissive hypotension until haemorrhage control (penetrating trauma)
Always think “treat first what kills first”

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Trauma: Initial Assessment and Management