Trauma Primary Survey & Hemorrhagic Shock
Systematic trauma resuscitation: ATLS primary and secondary survey, identifying life threats in seconds, balanced blood component resuscitation, tranexamic acid, and pelvic binding.
Resuscitation Quick Ribbon (First 2 Minutes)
Bottom-Line Clinical Pearl
Hemorrhagic shock is the leading cause of preventable trauma death. Stop the bleed. Replace blood with blood: activate Massive Transfusion Protocol (1:1:1 ratio of pRBCs : FFP : Platelets). Crystalloid fluids are strictly minimized (< 1 L) because they exacerbate the lethal triad of hypothermia, acidosis, and coagulopathy. Administer Tranexamic Acid (TXA 2g IV push or 1g over 10m then 1g over 8h) within 3 hours of injury. Bind pelvic ring fractures at the greater trochanters immediately.
1. The ATLS Primary Survey (ABCDE) with Immediate Life-Threat Interventions
| Component | Assessment | Can't-Miss Life Threat | Immediate Resuscitative Action |
|---|---|---|---|
| A - Airway & C-Spine | Vocalization, blood/vomitus, stridor, facial fractures | Airway loss, expanding hematoma | Suction, jaw thrust, ETT with in-line cervical stabilization; surgical cric if failed |
| B - Breathing | Chest excursion, breath sounds, trachea, chest wall | Tension pneumo, open pneumo, flail chest | Finger thoracostomy / needle decompression; 3-sided occlusive dressing; tube thoracostomy |
| C - Circulation | Radial/femoral pulse, pelvic stability, external bleed | Exsanguinating hemorrhage, pelvic fracture | Direct pressure / tourniquet, activate MTP (1:1:1), place pelvic binder at trochanters, TXA |
| D - Disability | GCS score, pupillary symmetry, gross motor movement | Epidural/subdural hematoma, herniation | If GCS <= 8 intubate; hypertonic saline (3% 250 mL) for uncal herniation (blown pupil) |
| E - Exposure & Environment | Completely expose patient, log roll for back | Hypothermia, occult penetrating wounds | Warm blankets, warm fluids, bear hugger; prevent the lethal triad |
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