Experience Summary

In this 360° video, observe a demonstration of a trauma primary survey performed in line with ATLS principles.

cABCDE Assessment

A trauma primary survey, following Advanced Trauma Life Support (ATLS) principles, is a rapid, structured assessment aimed at identifying and treating life-threatening injuries. Modern trauma practice incorporates Catastrophic Haemorrhage as the first priority, producing the cABCDE sequence: Catastrophic haemorrhage, Airway with cervical spine protection, Breathing and ventilation, Circulation, Disability, and Exposure. This ensures the clinician rapidly controls major external bleeding—one of the most preventable causes of trauma mortality—before progressing to airway or breathing assessment.

c - Catastrophic Haemorrhage

The initial step is to identify and immediately control massive external bleeding. This includes the rapid application of tourniquets, direct pressure, haemostatic dressings, or junctional devices as appropriate. If a major haemorrhage protocol is required, it is activated early. Only once catastrophic bleeding is controlled does the team advance to the airway assessment.

A - Airway with cervical spine protection

The airway is assessed for patency while strictly maintaining c-spine protection. Manual in-line stabilisation is held from first contact until the neck is immobilised. Patients are assessed for speech, obstruction, swelling, or facial trauma. Airway manoeuvres such as jaw thrust and suction may be used, avoiding head tilt. If the airway is threatened, early intubation or surgical airway intervention may be necessary.

B- Breathing and ventilation

Breathing is evaluated by observing chest wall movement, respiratory rate, and effort, as well as auscultation and pulse oximetry. Life-threatening thoracic conditions—including tension pneumothorax, open pneumothorax, massive haemothorax, and flail chest—are identified and managed immediately. Treatment may involve needle decompression, thoracostomy, or sealing open chest wounds. Oxygen is administered to optimise ventilation.

C - Circulation with Haemorrhage Control

Beyond catastrophic external bleeding, the clinician assesses for signs of shock, palpates pulses, evaluates skin perfusion, and secures IV or IO access. Internal haemorrhage is considered and may require imaging or surgical intervention. Fluid resuscitation and balanced blood product transfusion are initiated where appropriate, employing principles such as permissive hypotension in specific scenarios.

D - Disability (Neurological Assessment)

A rapid neurological assessment is made using AVPU or the Glasgow Coma Scale. Pupillary size and reactivity are checked. Hypoxia, hypovolaemia, and traumatic brain injury are considered as causes of altered mental status.

E - Exposure and Environmental Control

The patient is fully exposed to identify occult injuries, while warming measures are used to prevent hypothermia and the lethal triad.

After stabilising immediate threats, the team reassesses before proceeding to the secondary survey.

Learning Outcomes

1. Observe a trauma primary survey being performed.
2. Understand the components of a trauma primary survey.
3. Understand the differences between an A to E assessment and a trauma primary survey.

External Resources

• Trauma primary survey