Clinical Review ABC of emergency radiology

Major trauma

BMJ 2005; 330 doi: (Published 12 May 2005) Cite this as: BMJ 2005;330:1136
  1. Otto Chan,
  2. Alistair Wilson


    Advanced trauma life support is the standard method for the initial management of severely injured patients. The principle is simple—treat the greatest threat to life first. Loss of airway will kill before inability to breathe, and inability to breathe will kill before bleeding and loss of circulation. A definitive diagnosis is not necessary to treat the patient initially. The most important point to remember is that no harm should be done to the patient during treatment. The management of severely injured patients is divided into the primary and secondary survey. This article deals with the imaging during the primary survey.

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    ABCDE of trauma

    Primary survey

    The primary survey comprises a rapid evaluation of the patient, resuscitation, and institution of life preserving treatment. This process is called the ABCDE of trauma. Adjuncts to the primary survey include relevant imaging during resuscitation and re-evaluation.

    In practice, most of the steps of the ABCDE are carried out simultaneously by a trauma team. Anaesthetists will usually deal with the airway and intravenous access while the surgeon evaluates the chest, abdomen, and pelvis for potential life threatening injuries.

    Supine radiograph showing endotracheal tube 5 cm above carina (arrow)

    Imaging is requested as part of the primary survey while the patient is assessed, life threatening injuries are dealt with, and resuscitation procedures instituted. Imaging should not be performed if it interferes with the rest of the primary survey or definitive care, and only investigations that may have a direct effect on the patient's initial problems should be done.

    Examples of imaging done as part of the …

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