Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
ABCDE of trauma
Airway management
Airway management techniques
Ventilation (breathing) management
Circulatory management
Circulatory resuscitation measures
Secondary surgery
Chest trauma
Abdominal trauma
Head trauma
Spinal trauma
Neurological trauma
Limb trauma
Special trauma cases
Transport of critically ill patients
Trauma response
Activation plan for trauma team
Primary Trauma Care Manual | Primary trauma care manual


The management of severe multiple injury requires clear recognition of management priorities and the goal of the initial assessment is to determine those injuries that threaten the patient’s life. If performed correctly, this first survey (the “primary survey”) should identify such life-threatening injuries such as:

:: Airway obstruction
:: Chest injuries with breathing difficulties
:: Severe external or internal haemorrhage
:: Abdominal injuries.

If there is more than one injured patient, treat patients in order of priority (triage). Successful triage requires rapid assessment and clear thinking.


First, carry out the ABCDE survey:

:: Airway
:: Breathing
:: Circulation
:: Disability
:: Exposure.

The ABCDE survey is sometimes referred to as the “primary survey”. Its primary function is to diagnose and treat life threatening injuries which, if left undiagnosed and untreated, could lead to death:

:: Airway obstruction
:: Chest injuries with breathing difficulties
:: Severe external or internal haemorrhage
:: Abdominal injuries.

When more than one life threatening state exists, simultaneous treatment of injuries is essential and requires effective teamwork.


Assess the airway. Can the patient talk and breathe freely? If obstructed, consider the following steps.

:: Chin lift/jaw thrust (tongue is attached to the jaw)
:: Suction (if available)
:: Guedel airway/nasopharyngeal airway
:: Intubation; keep the neck immobilized in neutral position.


Assess airway patency and breathing adequacy by clinical observation. If inadequate, consider:

:: Artificial ventilation
:: Decompression and drainage of tension pneumothorax/haemothorax
:: Closure of open chest injury.

Reassess the ABCs if the patient is unstable.


Assess the patient’s circulation as you recheck the oxygen supply, airway patency and breathing adequacy. If inadequate, you may need to:

:: Stop external haemorrhage
:: Establish 2 large-bore IV lines (14 or 16 G) if possible
:: Administer fluids, if available.

Give oxygen, if available.


Make a rapid neurological assessment (is the patient awake, vocally responsive to pain or unconscious?) There is no time to do the Glasgow Coma Scale (page PCTM –23) so use the following clear, quick system at this stage:

A Awake
V Verbal response
P Painful response
U Unresponsive


Undress the patient and look for injury. If you suspect a neck or spinal injury, in-line immobilization is important.

Take care when moving the patient, especially if he or she is unconscious.

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