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The archetypal trauma patient - the young man pulled from a wrecked car, hypotensive and tachycardic, the patient around whom the primary survey, the trauma team activation call, and decades of trauma system design were constructed - is no longer the typical major trauma patient in the United Kingdom or in most high-income countries.
Why xABCDE Is a Syntax, Not a Language - and What Linguistics Teaches Us About Becoming Fluent in Resuscitation
As UK councils install public bleed-control cabinets during Knife Crime Awareness Week, the evidence for bystander tourniquets and wound packing is more contested than the headlines suggest. We examine what ATLS candidates must know.
The first randomised trial of augmented mean arterial pressure in acute spinal cord injury found no benefit and signals of harm, unsettling a guideline-driven consensus that has shaped trauma practice for more than two decades.
Medical educators must critically evaluate the construct and predictive validity of these expensive simulators. We must ensure that curriculum design prioritizes holistic, cognitive, and team-based training over the alluring, but potentially superficial, appeal of hyper-realistic physical models.
The two-litre crystalloid bolus, once the unchallenged cornerstone of trauma resuscitation, is now one of the most contested teachings in acute care.
Resuscitative thoracotomy remains a procedure defined by extremes: extraordinary benefit in a narrow population, and near-certain futility in everyone else. The evidence supports its use in penetrating thoracic injury with witnessed arrest and recent signs of life, where it addresses a mechanically reversible cause of cardiac arrest.
Whole-body CT has become routine in many major trauma centres based on compelling observational data from the German TraumaRegister, yet the only randomised controlled trial - REACT-2, published in The Lancet in 2016 — found no mortality benefit over selective ATLS-guided imaging, with identical 16% in-hospital death rates in both groups. For ATLS candidates, understanding this unresolved debate between comprehensive and selective imaging is increasingly important for clinical practice and viva.
Surgical stabilisation of rib fractures (SSRF) is rapidly gaining traction in trauma centres worldwide, with strong RCT evidence supporting its use in flail chest and ventilator-dependent patients - yet the ATLS course barely mentions it. The controversy intensifies for the much larger population with severe non-flail fracture patterns, where recent randomised trials have produced directly conflicting results.
Pelvic haemorrhage in trauma remains one of the genuinely unsolved problems in acute surgery. The debate between packing and embolisation has moved from adversarial to collaborative, with the best-evidenced centres now deploying both strategies in a carefully sequenced protocol. What the evidence consistently supports is speed, systematic decision-making, and the avoidance of delay at every stage of the pathway.
The hard cervical collar is a trauma staple, but growing evidence questions its routine use. Raised ICP, pressure injury, airway obstruction, and harm in penetrating trauma suggest a more selective approach — this post examines the evidence and what ATLS candidates need to know.
The CRASH-2 trial established TXA as a cornerstone of trauma resuscitation, but recent evidence - including the PATCH-Trauma RCT (NEJM, 2023) and fibrinolysis shutdown research - challenges its blanket use, especially prehospital. This post explores what ATLS candidates need to understand beyond the three-hour rule.