Mechanism, time, anticoagulants, allergies/medications, baseline function when available
Prehospital vitals/interventions and response
Pregnancy, comorbidity, tetanus and blood-product considerations
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← All presentations
Multiple Trauma / Primary Survey
Treat immediate threats in order; reassess after every intervention.
Your objective: explain the approach, recognize important warning signs, then test your recall.
Abbreviations explained
- ACS
- Acute coronary syndrome
- OMI
- Occlusion myocardial infarction
- ECG
- Electrocardiogram
- PE
- Pulmonary embolism
- POCUS
- Point-of-care ultrasound
- QTc
- QT interval corrected for heart rate
- LBBB
- Left bundle branch block
- RBBB
- Right bundle branch block
- hs-cTn
- High-sensitivity cardiac troponin
- CTA
- Computed tomography angiography
- ICU
- Intensive care unit
Filter
The jobTreat immediate threats in order; reassess after every intervention.
- 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.
Major trauma is a time-critical systems problem.
A structured primary survey prevents fixation on a visible injury while airway obstruction, tension physiology, hemorrhage, brain injury, or pelvic bleeding progresses.
Catastrophic hemorrhage Critical
Key: Tourniquet/pressure/pelvic stabilization and massive-transfusion pathway per local protocol; definitive control is surgical/IR.
Tension pneumothorax / massive hemothorax Critical
Key: Treat clinically in an unstable patient; do not wait for imaging.
Traumatic brain injury with herniation risk Critical
Key: Prevent hypoxia and hypotension; urgent neuro/trauma input.
Unstable pelvic, abdominal, or vascular injury Critical
Key: Shock after blunt/penetrating trauma needs rapid source-control decisions.
Spinal cord injury / airway burn Emergent
Key: Immobilize selectively by mechanism and examination; plan early airway support for inhalation injury.
Tick what your patient has — the banner updates as you go.
Primary survey with team communication and repeated vital trends
Head-to-toe secondary survey only after immediate threats are addressed
Distal pulses, neurologic status, log-roll/skin, temperature
Immediate
- eFAST, portable chest/pelvis imaging as indicated, blood gas/lactate/type and cross
- Massive-transfusion and tranexamic-acid pathways only under local trauma protocol
Imaging
- CT trauma series for stable or transient responder per team decision
- Do not send an unstable patient to CT when they need the operating room/IR
Reassessment
- Repeat primary survey after airway procedure, decompression, transfusion, movement, and clinical change
Medication safety reminder
Use this as a first-pass prompt; verify all medications, doses, concentrations, contraindications, weight, pregnancy status, and local protocols before administration.
Check indication, allergy, route, renal/hepatic risk, interactions, monitoring, and local formulary.
Discharge
- Only after a complete evaluation for low-risk trauma, normal observation when needed, and reliable precautions.
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.
Use objective reassessment and the local pathway.
Before the next decision · reassess and hand over
Use these learning prompts with the presentation’s pathway. They are not discharge criteria.
- Reassess: compare symptoms, observations and examination with the initial assessment and response to treatment.
- Warning signs for Multiple Trauma / Primary Survey:
- 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
- Reconsider: check unresolved findings and alternative explanations, including the pitfalls below.
- Escalate: communicate deterioration, uncertainty or needs beyond the current setting.
- Plan the transition: identify outstanding results, responsibility for follow-up, patient understanding and specific return advice.
Clinical Pearls
- The primary survey is a loop, not a checklist completed once.
- Do not make CT the destination of an unstable trauma patient.
Pitfalls
- Completing a secondary survey before hemorrhage or tension physiology is controlled.
- Treating a single normal pressure as proof that bleeding has stopped.
PRACTICE REFRESHER
Rapid recall
Test your first action and the dangerous diagnoses before revealing the answer.
01 · First move
Before you scroll, what needs to happen first?
Activate the trauma team and use local primary-survey, massive-transfusion, and imaging pathways.
02 · Immediate threats
Name at least two diagnoses that cannot wait.
Catastrophic hemorrhage · Tension pneumothorax / massive hemothorax · Traumatic brain injury with herniation risk
PRIVATE TO THIS DEVICE
Your learning note
Capture a weak point, a teaching pearl, or a question to take to your next shift.
Review schedule starts when marked reviewed
Selected guidance · source check 2026-09-07. These 1 source links support selected teaching points, not a complete review of this topic. Check population, setting and local protocol before applying a recommendation.
Resources and definitive care
Check the local trauma activation, trained procedural team and transfer arrangements. Imaging availability does not remove the need to respond to instability.
Source and scope
Supporting teaching points checked 2026-09-10. This is an educational synthesis, not an independently peer-reviewed protocol.
NICE NG39: major traumaConfirm patient context, full recommendations and local policy. External sources need an internet connection.
- Rosen’s Emergency Medicine, 10th ed. — multiple trauma and trauma systems
- ACS ATLS principles; local trauma and massive-transfusion protocols