General Surgery
Trauma: First Aid and Resuscitation
MBBS surgery notes on trauma resuscitation: the ABCDE primary survey, haemorrhage control and damage control principles, mapped to NMC codes SU17.1 to SU17.5.
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Trauma: First Aid and Resuscitation
MBBS surgery notes on trauma resuscitation: the ABCDE primary survey, haemorrhage control and damage control principles, mapped to NMC codes SU17.1 to SU17.5.
This chapter sets out the systematic approach to the injured patient, from first aid to structured resuscitation. It follows the primary survey ABCDE sequence and the principles of damage control resuscitation before definitive care.
High-yield: Trauma: First Aid and Resuscitation
- The primary survey follows the ABCDE sequence: airway with cervical spine control, breathing, circulation, disability and exposure.
- The airway is secured first while protecting the cervical spine in any patient with a significant mechanism of injury.
- Life-threatening chest injuries sought in the breathing step include tension pneumothorax, open pneumothorax, massive haemothorax and flail chest.
- Circulation is assessed and haemorrhage controlled with direct pressure, and two wide-bore cannulae are inserted for resuscitation.
- Disability uses the Glasgow Coma Scale and pupil examination to screen for brain injury.
- Exposure fully undresses the patient to find all injuries, then prevents hypothermia with warming.
- The Glasgow Coma Scale scores eye, verbal and motor responses from a total of 3 to 15; a score of 8 or less indicates a need to protect the airway.
- Tension pneumothorax is a clinical diagnosis treated immediately by needle or finger decompression, not by waiting for a chest radiograph.
- Permissive hypotension and early blood product transfusion are preferred to large crystalloid volumes in uncontrolled haemorrhage.
- Tranexamic acid given early after major trauma reduces death from bleeding.
- The focused assessment with sonography for trauma quickly detects free fluid in the abdomen and pericardium at the bedside.
- The secondary survey is a head-to-toe examination performed only after the primary survey and resuscitation.
- Hidden blood loss can pool in the chest, abdomen, pelvis, retroperitoneum and around long bone fractures.
- A pelvic binder controls venous bleeding by closing the pelvic ring in a suspected unstable pelvic fracture.
- Reassess airway, breathing and circulation whenever the patient deteriorates, returning to the top of the primary survey.
Primary survey ABCDE
- **Airway:** Secure the airway with cervical spine control; look for obstruction and protect if the coma score is 8 or less.
- **Breathing:** Find and treat tension pneumothorax, open pneumothorax, massive haemothorax and flail chest.
- **Circulation:** Control haemorrhage, gain wide-bore access, use blood products and tranexamic acid.
- **Disability and exposure:** Assess the Glasgow Coma Scale and pupils, then fully expose while preventing hypothermia.
NMC competencies in this chapter
- **SU17.1:** Primary survey and resuscitation of the trauma patient
- **SU17.2:** Airway and breathing management in trauma
- **SU17.3:** Circulation, haemorrhage control and shock in trauma
- **SU17.4:** Assessment of disability and the secondary survey
- **SU17.5:** First aid and initial care of the injured patient
- **SU10.4:** Monitoring and fluid management in resuscitation
Frequently Asked Questions
What does the primary survey assess?
It follows the ABCDE sequence: airway with cervical spine control, breathing, circulation with haemorrhage control, disability using the coma scale, and exposure while preventing hypothermia.
How is a tension pneumothorax managed?
It is a clinical diagnosis and must be decompressed immediately by needle or finger thoracostomy, followed by a chest drain, without waiting for a chest radiograph.
What is permissive hypotension?
Accepting a lower target blood pressure until bleeding is controlled, using balanced blood products rather than large crystalloid volumes to avoid worsening bleeding and coagulopathy.
Where can major hidden blood loss occur in trauma?
Blood can pool in the chest, abdomen, pelvis, retroperitoneum and around long bone fractures, so these sites must be assessed when there is unexplained shock.
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