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Trauma

Principles of Surgery in General · 14 questions · 1 free to try

The principles of trauma care set out in ATLS and the NICE major trauma guidance: primary survey and resuscitation, haemorrhage control and damage control resuscitation, head, spine and pelvic injury pathways, burns assessment and compartment syndrome.

Every question in this topic is a single best answer item in the style of the exam, followed by an explanation that gives the reasoning for the correct option, why each distractor is wrong, a key point to carry into the exam and, where one applies, the guideline or trial it rests on. Practice mode lets you work through the topic on its own or mixed with others; exam mode draws it into timed papers.

Sample question from this topic

A 24-year-old man is brought to the emergency department after a stabbing. Blood is spurting from a deep wound in the right groin, he is pale and drowsy, and he is making gurgling respiratory noises with blood in his mouth. The trauma team assembles. According to the ABCDE approach, what is the correct order of the FIRST two actions?

  1. AFull airway assessment with suction and adjuncts first, addressing the groin only when 'C' is reached
  2. BLog-roll to examine the back before anything else
  3. CControl the catastrophic external haemorrhage (pressure, packing or tourniquet) simultaneously with or immediately before securing the airway
  4. DObtain intravenous access and send bloods before touching the wound
  5. EComplete a secondary survey to catalogue all injuries first
Show answer and explanation

Correct answer: C

Modern trauma teaching modifies classical ABCDE to ABCDE: catastrophic external haemorrhage is addressed before, or simultaneously with, the airway, because a patient can exsanguinate from a major arterial wound faster than any airway problem kills. Spurting groin haemorrhage — a junctional injury where tourniquets cannot be applied — is controlled with firm direct pressure and haemostatic wound packing while the airway (obstructed with blood, in a drowsy patient) is cleared, suctioned and secured by a second team member. This is the essence of the horizontally organised trauma team: interventions run in parallel, but where sequencing is forced, external exsanguination outranks everything. The remaining primary survey then proceeds — breathing, circulation with haemorrhage control (blood products via the major haemorrhage protocol, not crystalloid), disability, exposure — with the secondary survey deferred until life threats are treated.

Why the others are wrong: A — sequencing the airway strictly first while an artery empties the circulation is the specific error the prefix exists to prevent. B — the log-roll belongs to the secondary survey. D — access and bloods matter but never precede compression of a spurting vessel. E — the secondary survey is a head-to-toe catalogue performed only after the primary survey is complete and resuscitation is underway.

Key point: The primary survey is ABCDE: catastrophic external bleeding is compressed, packed or tourniqueted first — in parallel with airway control by the team — because junctional arterial haemorrhage kills faster than an obstructed airway.

Guidelines: ATLS 10th edition and NICE major trauma guidance (NG39): catastrophic external haemorrhage is controlled first (ABC) — direct pressure, wound packing and tourniquet where applicable — before airway assessment.

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