One-page cheat sheet
Trauma: the primary survey
<C>ABCDE: treat as you find
palsurgery.comFree surgical teaching
<C>ABCDE
- <C> Catastrophic haemorrhage: direct pressure, tourniquet
- A Airway with cervical spine protection
- B Breathing and ventilation
- C Circulation with haemorrhage control
- D Disability: GCS, pupils, glucose
- E Exposure: log roll, prevent hypothermia
Airway
- Talking = patent airway
- Jaw thrust, suction, adjuncts; GCS 8 or less → definitive airway
- Failed intubation: surgical cricothyroidotomy
Breathing: life threats
- Tension pneumothorax: decompress (4th or 5th intercostal space, just anterior to the mid-axillary line, in adults), then chest drain
- Open pneumothorax: three-sided dressing, then drain
- Massive haemothorax: over 1500 mL or over 200 mL/h → thoracotomy
- Flail chest; cardiac tamponade (Beck’s triad)
Circulation
- Bleeding: floor and four more (chest, abdomen, pelvis, long bones)
- Two large-bore lines; warmed blood early; balanced 1:1:1 transfusion
- Tranexamic acid within 3 hours: 1 g over 10 min, then 1 g over 8 h
- Pelvic binder; eFAST; permissive hypotension (not with head injury)
Classes of shock
- I: under 15% blood loss, normal vital signs
- II: 15–30%, tachycardia, narrow pulse pressure
- III: 30–40%, blood pressure falls, confused
- IV: over 40%, life-threatening
Exam pearls
- Lethal triad: hypothermia, acidosis, coagulopathy → damage-control surgery
- Then the secondary survey: AMPLE history, head-to-toe examination
- Children: needle decompression in the 2nd intercostal space, mid-clavicular line