EM · Major trauma resuscitation
Major trauma resuscitation — the team-based systematic approach
Also known as Trauma resuscitation · Trauma team activation · Polytrauma
The major trauma resuscitation — the team activation and the structured roles, the primary survey (ABCDE) applied to the multiply-injured patient, the adjuncts (FAST, chest drain, pelvic binder, bloods, imaging), the damage-control resuscitation principles (permissive hypotension, blood-product-first, tranexamic acid), the secondary survey (the head-to-toe after the stabilisation), and the disposition decision. ACEM-primary, globally tagged.
Practise this topic
On this page & tools
Your progress
Saved locally on this device.
8 MCQs with explanations
Target exams
Red flags
Meet the patient
A 24-year-old motorcyclist is thrown eight metres at 70 km/h and arrives agitated and pale: an open right femoral shaft fracture bleeding freely, a distended tender abdomen, reduced air entry on the left, GCS 12, BP 78/52, HR 138. Before anyone touches the airway, a windlass tourniquet goes on the thigh; before anyone reaches for saline, the massive-haemorrhage protocol is running.[1]
The two questions that will decide his next hour are the two that decide every major trauma: is the bleeding controlled? (the C step answers in 30 seconds) and does he respond to blood? (the whole disposition turns on it). Hold those two and the algorithm falls into place.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
References8Show ledgerHide ledger
- [1]Mitra B, Reade MC, Bernard S, et al. High ratio of plasma to red cells in contemporary resuscitation of haemorrhagic shock after trauma: a secondary analysis of the PATCH-trauma trial Scand J Trauma Resusc Emerg Med, 2025.PMID 41039456
- [2]Al Ma'ani M, Nelson A, Castillo Diaz F, et al. A narrative review: Resuscitation of older adults with hemorrhagic shock Transfusion, 2025.PMID 39985371
- [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
- [4]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
- [5]Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition Crit Care, 2023.PMID 36859355
- [6]Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital J Trauma, 2007.PMID 18090009
- [7]Morrison JJ, Dubose JJ, Rasmussen TE, et al. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study Arch Surg, 2012.PMID 22006852
- [8]Huber-Wagner S, Lefering R, Qvick LM, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study Lancet, 2009.PMID 19321199