Assess and stabilize trauma patients with an organized approach, anticipating complications in a timely fashion, using the primary and secondary surveys.
Suspect, identify, and immediately begin treating lifethreatening complications (e.g., tension pneumothorax, tamponade).
When faced with several trauma patients, triage according to resources and treatment priorities.
In trauma patients, secure the airway appropriately (e.g., assume cervical spine injury, use conscious sedation, recognize a difficult airway, plan for back-up methods/cricothyrotomy).
In a patient with signs and symptoms of shock:
Recognize the shock.
Define the severity and type (neurogenic, hypovolemic, septic).
Treat the shock.
In trauma patients, rule out hypothermia on arrival and subsequently (as it may develop during treatment).
Suspect certain medical problems (e.g., seizure, drug intoxication, hypoglycemia, attempted suicide) as the precipitant of the trauma.
Do not move potentially unstable patients from treatment areas for investigations (e.g., computed tomography, X-ray examination).
Determine when patient transfer is necessary (e.g., central nervous system bleeds, when no specialty support is available).
Transfer patients in an appropriate manner (i.e., stabilize them before transfer and choose the method, such as ambulance or flight).
Find opportunities to offer advice to prevent or minimize trauma (e.g., do not drive drunk, use seatbelts and helmets).
In children with traumatic injury, rule out abuse. (Carefully assess the reported mechanism of injury to ensure it corresponds with the actual injury.)
Treat life-threatening and multiple-system injuries first
In mass-casualty event (number of patients and severity of injuries exceed capability of facility and staff), treat patient with greatest chance of survival requiring least amount of time, equipment, supplies, personnel
Note: Aggressive IV fluids have been suggested to increase mortality (increase wound bleeding, coagulation factor dilution, abdominal compartment syndrome)
Consider Tranexamic acid 1g over 10 mins then 1g over 8 hours (onset ideally within 3h of injury)