ABCs of Trauma

This Daily Doodle acts as a simple visual reminder of the steps involved in the primary survey of a trauma patient. Remember your ABCs (plus D and E). Quick overview:

A – Airway with Cervical Spine Control: Assume cervical spine injury if any injury above the clavicle, altered level of consciousness or multiple trauma. Stabilize the C-Spine with an appropriate sized collar or manual stabilization/support. Speak to the patient, if the patient responds, airway is patent, if patient does not respond, try to visualize airway for obvious obstruction. Suction vomit/mucus if present. Beware of snoring/gurgling (sign of obstruction). O2 mask. Secure airway (will be discussed in another doodle).

B – Breathing: Assess adequacy of ventilation, look for symmetric rise/fall of chest, midline trachea, peripheral signs (flared nostrils, accessory muscles), listen to both lungs. Count the respiratory rate.

C – Circulation and hemorrhage control: Control external hemorrhage with direct pressure. Measure blood pressure and heart rate. Rapid assessment of blood pressure by palpation: carotid pulse (systolic BP >60 mm Hg), femoral pulse (systolic BP >70 mm Hg) and radial pulseĀ  (systolic BP >80 mm Hg). Look for signs of shock (tachycardia, tachypnea, decreased capillary refill, cool extremities, decreased urine output, narrowed pulse pressure, decreased level of consciousness and hypotension).

D – Disability / Dysfunction of Central Nervous System: Brief neurologic exam including level of consciousness, pupil size and reactivity, speech, and motor function. Determine and record Glasgow Coma Scale.

E – Environment / Exposure: Cut away all clothing with scissors to fully expose patient for proper assessment. Keep patient warm when not being examined. Keep environment at warm temperature.




  1. P. Driscoll and D. Skinner. “ABC of major trauma. Initial assessment and management–I: Primary survey.” BMJ. May 1990.
  2. P. Rowe. “Trauma”. UBC Academic Half-Day Lecture Series. February, 2013.


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Airway Management



02/26/13 – “ABCs of Trauma” Daily Doodle by Michiko Maruyama

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