Multiple Trauma / Primary Survey

Treat immediate threats in order; reassess after every intervention.

Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

Activate the trauma team and use local primary-survey, massive-transfusion, and imaging pathways.
Address catastrophic external hemorrhage, then airway, breathing, circulation, disability, and exposure with repeated reassessment.
Use physiology and mechanism to guide imaging; a stable patient can deteriorate during transfer or scanning.

Hypotension, tachycardia, altered mental status, or rising lactate
Penetrating torso/neck trauma or high-risk mechanism
Unilateral absent breath sounds, distended neck veins, severe respiratory distress
Unstable pelvis, abdominal distension, external hemorrhage
Anticoagulation, pregnancy, frailty, or pediatric age

eFAST, portable chest/pelvis imaging as indicated, blood gas/lactate/type and cross
Massive-transfusion and tranexamic-acid pathways only under local trauma protocol

Catastrophic hemorrhage
Tourniquet/pressure/pelvic stabilization and massive-transfusion pathway per local protocol; definitive control is surgical/IR.
Tension pneumothorax / massive hemothorax
Treat clinically in an unstable patient; do not wait for imaging.
Traumatic brain injury with herniation risk
Prevent hypoxia and hypotension; urgent neuro/trauma input.
Unstable pelvic, abdominal, or vascular injury
Shock after blunt/penetrating trauma needs rapid source-control decisions.

Admit / trauma service

Significant injury, serial examination need, anticoagulation/frailty risk, or pain/functional barrier.

OR / IR / ICU / transfer

Ongoing hemorrhage, airway/thoracic emergency, major TBI, unstable spine, or need for higher-level trauma care.