Trauma Assessment & Shock
Trauma kills in predictable ways — airway loss, tension physiology, and hemorrhagic shock. A disciplined primary survey catches all three before they become terminal.
EMT · AEMT · Paramedic
Scene size-up and MOI
Before touching the patient: scene safety, BSI, number of patients, resources, and mechanism. Significant MOI (falls > 20 ft, high-speed MVC, ejection, penetrating trunk/head/neck) triggers full spinal considerations and rapid transport.
Primary survey (XABCDE)
Exsanguinating hemorrhage first — tourniquet or direct pressure. Then Airway, Breathing, Circulation, Disability (GCS/pupils), Exposure. Fix life threats as you find them; don't move on until each is addressed.
Rapid trauma exam and DCAP-BTLS
Head-to-toe, 60–90 seconds, looking for Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling. Every region gets inspected and palpated.
Compensated shock
Tachycardia, cool clammy skin, narrowing pulse pressure, anxiety, delayed cap refill. BP is still normal — this is where you catch it. Waiting for hypotension means you missed the window.
- Control external bleeding immediately
- High-flow O2 if hypoxic
- Warm the patient — hypothermia worsens coagulopathy
- IV access en route; permissive hypotension (SBP ~90) if internal hemorrhage
Decompensated shock
Hypotension, altered mental status, weak or absent peripheral pulses. Load-and-go — surgical hemorrhage control is the only fix and it's not on your truck.
The lethal triad
Hypothermia, acidosis, and coagulopathy feed each other in major trauma. Prevent hypothermia aggressively — blankets, warm fluids, cabin heat.
Frequently asked
- How much crystalloid should you give in hemorrhagic shock?
- Modern EMS practice is permissive hypotension: target SBP ~90 (or radial pulse) with small boluses (250–500 mL) — over-resuscitation dilutes clotting factors and blows off soft clots.
- When do you use a tourniquet vs pressure?
- Tourniquet for life-threatening extremity hemorrhage not controlled by direct pressure — apply high and tight, note the time, don't remove in the field.
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