Initial trauma assessment: the primary survey
The first minutes after injury: a step-by-step primary survey to find and treat life-threatening problems in order.
Checked against sourcesVerified 31 October 2026
Emergency medicine
The first hour: resuscitation, the approach to the acutely unwell patient, poisoning and environmental emergencies.
Introduction
Emergency medicine is the care of people with sudden, serious illness or injury, and its skill is doing the right thing in the right order when the diagnosis is not yet known. The primary survey, the ABCDE approach and early recognition of the patient who is getting worse are the backbone of every topic in this section.
This section starts with resuscitation and the primary survey, then injuries of the head, neck, spine and chest, injuries of the abdomen, pelvis and limbs, environmental and other emergencies, poisoning and drug emergencies, and finally reference material.
Every topic uses the same layout: a short summary, what you should be able to do afterwards, the mechanism, the clinical picture, tests, treatment and the traps. Doses, thresholds and cut-offs are checked against named guidelines and shown with their source, because guidelines and countries sometimes differ.
How to study emergency medicine
Learn the emergency pathways as sequences you can say aloud: airway, breathing, circulation, disability, exposure, then the next three actions for the specific problem. For each topic ask what would make you call for help or move the patient immediately.
Learn the numbers that change what you do: blood pressure and heart rate in shock classes, the Glasgow Coma Scale, the times in stroke and cardiac arrest, antidote doses. The check-yourself questions at the end of each topic test them a few days later.
Link emergencies to the organ chapters: most emergencies are the acute form of a disease taught elsewhere, so follow the related links. Content here is for study and does not replace local protocols or a senior clinician's judgement.
Contents by part
The topics below are in teaching order. Each part builds on the one before it.
- Resuscitation and the primary survey. The first minutes of a seriously ill or injured patient: the primary and secondary survey, shock and transfusion, cardiac arrest, special populations and major incidents.
- Head, neck, spine and chest injury. Injuries above the diaphragm: brain and spinal cord, face and neck, chest wall, lung, heart and great vessels.
- Head and spinal cord injury in the trauma patient
- Traumatic brain injury: intracranial haemorrhage, diffuse
- Concussion and skull fractures
- Spinal cord injury
- Neck and facial trauma
- Thoracic trauma
- Chest wall and lung injury: rib fractures, flail chest
- Cardiac tamponade, blunt aortic injury and diaphragmatic
- Abdominal, pelvic and limb injury. Injuries below the diaphragm and of the limbs: solid and hollow organs, urinary tract, vessels, fractures, hands, crush and wounds.
- Abdominal and pelvic trauma
- Abdominal solid organ and hollow viscus injury
- Genitourinary trauma
- Vascular trauma
- Pelvic and hip fractures
- Long-bone fractures, fat embolism and dislocations
- Principles of fracture management, open fractures and
- Hand injuries
- Blast and crush injury
- Wound assessment, laceration repair and tetanus prophylaxis
- Environmental and other emergencies. Heat and cold, drowning, burns and inhalation, bites and stings, anaphylaxis, eye and ENT emergencies, the unconscious patient and pain relief.
- Hypothermia and hyperthermia
- Frostbite and cold injury
- Drowning, electrical and altitude injury
- Inhalation injury and burn resuscitation
- Animal bites, stings and envenomation
- Anaphylaxis and angioedema in adults
- Eye emergencies
- Epistaxis and ENT emergencies
- Approach to the unconscious patient and coma
- Acute pain management and procedural sedation
- Poisoning and drug emergencies. The approach to the poisoned patient, the common serious poisonings and their antidotes, drug intoxication and withdrawal, and drug interactions and side effects.
- Toxidromes and approach to the poisoned patient
- Paracetamol overdose
- Salicylate, lithium and iron poisoning
- Opioid, sedative, tricyclic and cardiac drug overdose
- Toxic alcohols: methanol and ethylene glycol poisoning
- Organophosphate and pesticide poisoning
- Carbon monoxide and cyanide poisoning
- Methaemoglobinaemia and arsenic poisoning
- Antidotes and management of common poisonings
- Drug intoxication and withdrawal
- Common drug interactions and reactions
- Major drug side effects
- Reference. Vitamin deficiencies and common laboratory reference values.
Topics
Secondary survey and penetrating trauma
Secondary survey and penetrating trauma: AMPLE history, head-to-toe exam, neck zones, penetrating chest, abdomen and extremity injuries, impaled objects and.Checked against sourcesVerified 31 October 2026Haemorrhagic shock, trauma resuscitation and massive
Haemorrhagic shock after trauma: ATLS classes, permissive hypotension, damage-control resuscitation, massive transfusion, TXA and coagulation care.Checked against sourcesVerified 31 October 2026Shock
What shock is, the four types, bedside assessment, lactate, fluids, vasopressors and the emergency algorithm.Checked against sourcesVerified 31 October 2026Cardiac arrest and basic advanced life support
Cardiac arrest recognition, high-quality CPR, defibrillation, drugs, reversible causes, post-arrest care and the 2025 ILCOR, AHA and Resuscitation Council.Checked against sourcesVerified 31 October 2026Trauma in pregnancy, children and older adults
How major injury differs in pregnancy, childhood and old age: physiology, assessment and what to adjust.Checked against sourcesVerified 31 October 2026
Major incident and disaster triage
A practical guide to recognising a major incident, the START and SALT triage systems, the METHANE report, hospital response and CBRN basics.Checked against sourcesVerified 31 October 2026Head and spinal cord injury in the trauma patient
Traumatic brain and spinal cord injury in the adult trauma patient: recognition, classification, imaging and evidence-based acute management.Checked against sourcesVerified 31 October 2026Traumatic brain injury: intracranial haemorrhage, diffuse
Traumatic brain injury: primary and secondary injury, intracranial haemorrhage, diffuse axonal injury, raised ICP, CT criteria and acute management.Checked against sourcesVerified 31 October 2026Concussion and skull fractures
Concussion (mild TBI) and skull fractures: mechanism, assessment tools, return to play, PCS, fracture types and CSF leak.Checked against sourcesVerified 31 October 2026Spinal cord injury
Traumatic spinal cord injury: anatomy, ASIA grading and incomplete syndromes, shock and autonomic dysreflexia, cervical clearance rules, steroids, surgery.Checked against sourcesVerified 31 October 2026Neck and facial trauma
Neck and facial trauma: penetrating neck injury, airway and vascular damage, facial fractures, dental trauma, nasal septal haematoma.Checked against sourcesVerified 31 October 2026Thoracic trauma
Managing penetrating and blunt chest injury: assessment, life-saving interventions, diagnosis, and chest wall and organ-specific care.Checked against sourcesVerified 31 October 2026Chest wall and lung injury: rib fractures, flail chest
Blunt thoracic trauma: rib fractures, flail chest, pulmonary contusion, pneumothorax and haemothorax — diagnosis and management with WSES 2025 guidance.Checked against sourcesVerified 31 October 2026Cardiac tamponade, blunt aortic injury and diaphragmatic
Cardiac tamponade, blunt aortic injury and traumatic diaphragmatic rupture: emergency recognition, imaging, resuscitation and repair.Checked against sourcesVerified 31 October 2026Abdominal and pelvic trauma
Blunt and penetrating injury to the abdomen and pelvis: assessment, solid and hollow organ damage, pelvic fractures, and abdominal compartment syndrome.Checked against sourcesVerified 31 October 2026Abdominal solid organ and hollow viscus injury
Trauma to abdominal solid organs and hollow viscera: mechanisms, imaging, grading, non-operative and operative management, guideline-based care.Checked against sourcesVerified 31 October 2026Genitourinary trauma
Renal, ureteric, bladder, urethral, penile and testicular trauma: grading, diagnosis and management.Checked against sourcesVerified 31 October 2026Vascular trauma
A clinical guide to recognising vascular injury in trauma, imaging it, repairing or shunting it, and preventing compartment syndrome and reperfusion injury.Checked against sourcesVerified 31 October 2026Pelvic and hip fractures
Pelvic ring injuries, haemorrhage control, hip fracture types, surgical timing, orthogeriatric care and complications.Checked against sourcesVerified 31 October 2026Long-bone fractures, fat embolism and dislocations
Emergency recognition and management of long-bone shaft fractures and fixation, fat embolism syndrome, common dislocations and neurovascular checks.Checked against sourcesVerified 31 October 2026Principles of fracture management, open fractures and
Core principles of fracture care: descriptions, healing, complications, reduction, immobilisation, open fractures and compartment syndrome.Checked against sourcesVerified 31 October 2026Hand injuries
Assessment and management of hand injuries: tendons, nerves, circulation, fingertip injuries, bites and felon, amputation, replantation, and compartment.Checked against sourcesVerified 31 October 2026Blast and crush injury
Primary to quaternary blast injury, blast lung, crush syndrome, rhabdomyolysis, tourniquets, and field-to-hospital management.Checked against sourcesVerified 31 October 2026Wound assessment, laceration repair and tetanus prophylaxis
How to assess and clean a wound, choose closure with sutures, glue or strips, decide on antibiotics, and give tetanus vaccine and immunoglobulin.Checked against sourcesVerified 31 October 2026Hypothermia and hyperthermia
How cold and hot patients are recognised and treated in emergency care, from J waves and rewarming rules to heat stroke cooling and drug-induced hyperthermia.Checked against sourcesVerified 31 October 2026Frostbite and cold injury
Freezing and non-freezing cold injuries: recognition and treatment, from frostnip and frostbite rewarming to iloprost, thrombolysis and trench foot.Checked against sourcesVerified 31 October 2026Drowning, electrical and altitude injury
Chain and resuscitation for drowning, electrical and lightning injury, acute mountain sickness, HACE and HAPE, and decompression sickness.Checked against sourcesVerified 31 October 2026Inhalation injury and burn resuscitation
Recognising inhalation injury, protecting the airway, treating carbon monoxide and cyanide, and resuscitating large burns.Checked against sourcesVerified 31 October 2026Animal bites, stings and envenomation
Aetiology, wound care, closure and prophylaxis of mammalian bites, stings and envenomation, including tetanus and rabies, with treatment tables.Checked against sourcesVerified 31 October 2026Anaphylaxis and angioedema in adults
How to recognise and treat anaphylaxis and angioedema in adults, including adrenaline doses, biphasic reactions, ACE inhibitor and hereditary angioedema.Checked against sourcesVerified 31 October 2026Eye emergencies
Sight- and life-threatening eye emergencies: recognise, triage and initial management.Checked against sourcesVerified 31 October 2026Epistaxis and ENT emergencies
Bleeding from the nose and other ear, nose and throat emergencies: what to do first, when to pack or cauterise, and when hearing loss or a sore throat is.Checked against sourcesVerified 31 October 2026Approach to the unconscious patient and coma
A pathway for assessing and managing the unconscious patient: GCS, causes, immediate treatment, herniation, brainstem death criteria and guidance.Checked against sourcesVerified 31 October 2026Acute pain management and procedural sedation
Acute pain and procedural sedation in the emergency department: analgesic choices, ketamine, nitrous oxide, monitoring, reversal and discharge criteria.Checked against sourcesVerified 31 October 2026Toxidromes and approach to the poisoned patient
How to resuscitate, assess, recognise toxidromes and manage poisoning: history, ECG, anion gap, osmolar gap, decontamination and enhanced elimination.Checked against sourcesVerified 31 October 2026Paracetamol overdose
How paracetamol harms the liver, how to read the Rumack-Matthew nomogram, and how acetylcysteine and transplant teams limit damage.Checked against sourcesVerified 31 October 2026Salicylate, lithium and iron poisoning
Salicylate, lithium and iron poisoning: recognition, mixed acid-base disorders, phases and treatments from alkalinisation to deferoxamine and dialysis.Checked against sourcesVerified 31 October 2026Opioid, sedative, tricyclic and cardiac drug overdose
How opioids, benzodiazepines, tricyclic antidepressants, beta-blockers, calcium channel blockers and digoxin poison, and the specific antidotes that reverse.Checked against sourcesVerified 31 October 2026Toxic alcohols: methanol and ethylene glycol poisoning
Methanol and ethylene glycol poisoning: toxic metabolites, anion and osmolar gaps, visual and renal injury, fomepizole (or ethanol), and haemodialysis.Checked against sourcesVerified 31 October 2026Organophosphate and pesticide poisoning
Cholinergic crisis, atropine and oximes, intermediate syndrome, paraquat, and the global burden of pesticide poisoning.Checked against sourcesVerified 31 October 2026Carbon monoxide and cyanide poisoning
Carbon monoxide and cyanide poisoning: sources, mechanisms, features, diagnosis, and treatment, including 100% oxygen, antidotes, and a comparison table.Checked against sourcesVerified 31 October 2026Methaemoglobinaemia and arsenic poisoning
Two poisonings that turn blood and gut upside down: how methaemoglobin and arsenic are recognised, tested for, and treated.Checked against sourcesVerified 31 October 2026Antidotes and management of common poisonings
How to assess a poisoned patient, when to decontaminate, and the antidote or treatment for common overdoses, with algorithms and doses.Checked against sourcesVerified 31 October 2026Drug intoxication and withdrawal
Toxidromes, intoxication and withdrawal syndromes: recognition, initial management, alcohol withdrawal, opioids, stimulants, and benzodiazepines.Checked against sourcesVerified 31 October 2026Common drug interactions and reactions
Mechanisms of drug interactions and drug-induced reactions, with common syndromes, hypersensitivity types, and prevention and reporting.Checked against sourcesVerified 31 October 2026Major drug side effects
A clinician's table of major adverse effects by drug class, how to recognise them, and how to manage them.Checked against sourcesVerified 31 October 2026Vitamin deficiencies
Vitamin deficiencies in the emergency department: causes, deficiency syndromes, diagnosis, treatment, refeeding, and prevention.Checked against sourcesVerified 31 October 2026Common laboratory reference values
Adult reference ranges for blood chemistry, haematology, blood gases and urine, in conventional and SI units, and how to interpret them.Checked against sourcesVerified 31 October 2026