Test trauma disclaimer

Before we begin, a quick guideline update. The Advanced Trauma Life Support, or ATLS, guidelines for the primary survey were updated in 2025.   Instead of ABCDE, the trauma assessment now follows xABCDE, where the x stands for eXsanguinating or eXternal hemorrhage. This means you should emergently control life-threatening bleeding before addressing the airway. This is because when clinicians spend time on airway management, patients with severe bleeding could lose so much blood that they could not return to circulation. Because bleeding control can often be started in seconds, it now comes first.  Depending on the situation, consider placing a tourniquet, using a pelvic binder for compression, packing the wound, or maintaining direct pressure on the bleeding area.   So, as you watch the video, keep an eye out for anywhere you see ABCDE and remember it’s now xABCDE, and check out the newly updated Decision-Making Tree below the video. Trauma is one of the major causes of mortality and morbidity worldwide. A standardized approach to trauma, known as the “trauma protocol” allows providers to systematically assess and quickly identify potentially life-threatening injuries, while simultaneously initiating resuscitation. The trauma protocol is composed of primary, secondary, and tertiary surveys, performed one after another. The goal is to first identify life-threatening injuries and stabilize the patient; then, perform a more thorough head-to-toe assessment to catch the not-so-obvious injuries; and finally, follow up 24 hours later to make sure no other injuries were missed. This protocol is performed on every trauma patient regardless of the mechanism of injury. 

So, when a patient presents with trauma, start with a primary survey. which can be summarized as A, B, C, D, and E. 

A stands for Airway. Ensure your patient has an open airway and the ability to maintain a patent airway. Start by asking them their name and what happened. If they can speak, they have an open airway. However, if they show any signs of airway compromise, such as altered mental status, gurgling noises, inability to speak clearly, or evidence of an expanding neck hematoma, secure the airway as soon as possible. In this case, intubate or consider obtaining a surgical airway via cricothyroidotomy. Also, stabilize the C-spine to maintain cervical spine restriction by placing a cervical collar and keeping it in place until a traumatic injury to this area has been ruled out.