Patient Assessment and Stabilization
Primary survey and stabilization
Use a reproducible ABCDE approach: airway with cervical-spine consideration, breathing with waveform capnography and pulse oximetry, circulation with an adequate-size BP cuff and two large-bore lines when indicated, disability with GCS and pupils, and exposure with temperature control. The secondary survey looks for distracting injuries, medication history, allergies, and baseline function. Flight adds constraints: noise, vibration, limited space, and delayed access, so stabilize what is time-critical before or during transport. Traps include treating a single blood pressure rather than trends and perfusion, missing a tension pneumothorax because breath sounds are hard to hear, overestimating SpO2 in poor perfusion, and failing to reassess after each intervention. Shock may be compensated in young adults, and elderly patients may be normotensive until late. For time-sensitive trauma, “load and go” may be safer than lengthy scene stabilization; for medical patients, optimize oxygenation, ventilation, glucose, and hemodynamics first. Worked example: a trauma patient has hypotension, absent breath sounds on one side, and worsening agitation. The correct priority is needle decompression per protocol before prolonged packaging, because obstruction of venous return will not respond to fluids alone. Rule of thumb: if an immediately life-saving intervention can be done safely and quickly, do it before transport; otherwise transport toward definitive care and reassess en route.