Initial assessment and management

• Airway management:

  • RSI and intubation
  • If RSI fails, use basic airway manoeuvres and adjuncts and/or supraglottic device until a surgical airway or assisted tracheal placement is performed
• Chest decompression of tension pneumothorax:

  • Perform chest decompression before imaging only if they have either haemodynamic instability or severe respiratory compromise
  • Open thoracostomy followed by chest drain
• Imaging for chest trauma:

  • Immediate chest x-ray and/or eFAST as part of primary survey
  • Consider immediate CT for adults with suspected chest trauma without severe respiratory compromise or have normal haemodynamic status
• Use intravenous tranexamic acid as soon as possible in patients with major trauma and active or suspected active bleeding.

  Do not use more than 3 hours after injury
• Use prothrombin complex concentrate immediately in adults with major trauma who have active bleeding and need emergency reversal of a vitamin K antagonist.
• For patients with major trauma, use intravenous morphine as the first‑line analgesic and adjust the dose as needed to achieve adequate pain relief.
• Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound (POCUS) performed at the time of presentation of a trauma patient, scans 5 regions

  • Pericardial - pericardium, liver, epigastric region
  • Right flank
  • Left flank
  • Pelvic
  • Pleural
• The initial assessment after hospital admission is divided into the following phases:

  1. Primary survey
  2. Adjuncts to primary survey and resuscitation
  3. Secondary survey (head to toe exam and history)
  4. Adjuncts to secondary survey
  5. Continues post-resuscitation monitoring and re-evaluation
  6. Definitive care