Strict cABCDE order: control catastrophic bleeding first, and fix each problem the moment you find it.
Catastrophic external hemorrhage
Direct pressure or tourniquet before anything else — even the airway.
Tension pneumothorax / flail chest
Immediate needle decompression then a drain — a clinical diagnosis.
Internal bleeding (abdomen/pelvis/chest)
eFAST + pelvic binder + early theatre/transfer decision.
Cardiac tamponade
Penetrating chest trauma with shock — the pericardial eFAST window.
Raised intracranial pressure
A unilateral blown pupil + falling GCS = impending herniation.
Repeat the primary survey after every intervention and every deterioration — trauma is dynamic.
The lethal triad: hypothermia + acidosis + coagulopathy — warming the patient treats the bleeding.
Short scene time, early tourniquet, pelvic binder on a suggestive mechanism, and a trauma-team pre-alert.
Five sources: chest, abdomen, pelvis, long bones, the floor.
Distended neck veins with shock.
Hypotension with bradycardia and warm limbs after cord injury.
Warning
Tranexamic acid 1 g IV within 3 hours of bleeding trauma — beyond that no benefit and possible harm.
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This content is an educational reference and does not replace clinical judgement or local protocols.
