Emergency MedicineSurgery
Major Trauma — Primary Survey (ATLS)
Systematic ATLS primary survey approach to major trauma: ABCDE with simultaneous haemorrhage control, C-spine precautions, and activation of major haemorrhage protocol.
Source: ATLS 10th Edition; JRCALC; NICE NG39
Step 1 of ~7
action
Scene Safety and Primary Survey Activation
Simultaneous actions on arrival:
• Activate trauma team — assign roles
• Log-roll with in-line C-spine immobilisation if mechanism suggests spinal injury
• Apply manual pressure to external haemorrhage
• Notify blood bank: major haemorrhage protocol if massive haemorrhage suspected
• IV/IO access × 2 large-bore (antecubital or IO tibia)
Primary survey: A-B-C-D-E (treat life threats as found — don't complete survey before treating)
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Tranexamic Acid (Surgical / Trauma Haemorrhage) · Antifibrinolytic (Haemostatic)
- Neostigmine · Anticholinesterase (Reversal Agent)
- Prilocaine · Local Anaesthetic (Amide)
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Mepivacaine with adrenaline · Amide LA + vasoconstrictor
Pathways
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
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MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only. Always apply local guidelines and clinical judgement.