The integrated major trauma resuscitation

The parallel approach begins at the arrival, with the trauma team activated and the roles allocated. Three streams run simultaneously: Stream 1 — Primary survey. C: tourniquet on the bleeding femur. A: airway with c-spine protection, prepare for RSI if the GCS is low. B: oxygen, assess for the five life-threatening chest injuries. C: two large-bore IVs, FAST scan. D: GCS, pupils, glucose. E: expose and keep warm. Stream 2 — Damage-control resuscitation. Activate the MTP. Resuscitate with blood products in a 1-to-1-to-1 ratio (not crystalloid).^[2][3] Give tranexamic acid 1 gram bolus then 1 gram over 8 hours (within the 3-hour window).^[1][3] Apply permissive hypotension (systolic 80 to 90 mmHg) until bleeding is controlled.^[3] Prevent the lethal triad: warm the patient, warm the fluids, correct the acidosis.^[3] Stream 3 — Source control. The FAST will likely show free fluid in the abdomen. The unstable patient with a positive FAST goes to the operating theatre for damage-control laparotomy, not the CT scanner. The femur is splinted. The pelvic binder is applied if the pelvis is unstable. The decision: this patient is unstable (BP 70, distended abdomen). The destination is the operating theatre. The CT is deferred until the physiology is stabilised. The damage-control laparotomy controls the bleeding (packing, ligation), the contamination (if a hollow-viscus injury is found), and the abdomen is left open for the planned second-look. The resuscitation continues into the ICU where the lethal triad is corrected before the definitive surgery.^[2][3]