MRCEM/FRCEM OSCE( Major Trauma )

RCEM OSCE( Major Trauma )
Approach to Adult Major Trauma – MRCEM OSCE Summary
1. Preparation & Team Leadership 

• Introduce yourself as the team leader on arrival. 

• Perform a quick team brief. • Allocate roles clearly (airway, circulation, runner, scribe) based on team members’ capabilities. 

• Ensure PPE and scene safety. 

• Call for help early — activate the trauma team and consider Major Haemorrhage Protocol if required.

2. Primary Survey – ABCDE Approach
Structured, with simultaneous life-saving interventions: 

• A – Airway + C-Spine Protection 

• Check patency, use jaw thrust, suction, adjuncts (OPA/NPA), or RSI if indicated. 

• Maintain C-spine immobilisation throughout. 

• B – Breathing 

• Assess chest rise, RR, oxygen sats. 

• Manage tension pneumothorax, haemothorax, open chest wounds, flail chest. 

• Give high-flow oxygen, insert chest drain if needed. 

• Consider FAST scan if available. 

• C – Circulation with Haemorrhage Control 

• Assess pulse, BP, cap refill. 

• Stop external bleeding (pressure, tourniquet). 

• Apply pelvic binder if indicated. 

• Insert 2x large-bore IV lines, send bloods (FBC, clotting, crossmatch, lactate). 

• If unstable: resuscitate with O-negative blood. 

• Activate Major Haemorrhage Protocol if ongoing bleeding. 

• D – Disability 

• Assess GCS, pupils, blood glucose. 

• E – Exposure & Environment 

• Fully expose the patient to identify hidden injuries. 

• Prevent hypothermia using blankets, warm fluids, and warm environment.

3. Reassessment 

• Reassess ABCDE after each intervention to evaluate response and detect deterioration. 

• Monitor vital signs, GCS, and clinical progress closely. 

• Be prepared to escalate care or repeat interventions.

4. Communication & Handover 

• Use clear, calm leadership and closed-loop communication. 

• Involve senior clinicians early. 

• Use structured handovers (e.g., ATMIST). 

• If the patient is conscious, offer brief, reassuring explanations.
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Note: Trauma in special populations (e.g. paediatrics, pregnancy, elderly, anticoagulated patients) will be covered in upcoming posts.

_{Khaled Khalifa}

_{Consultant Emergency Medicine}

_{Manchester University NHS Foundation Trust, UK}

_{Wythenshawe Hospital}