There is a mantra to resuscitation – address the “ABCs” – that has been taught for years and still has a firm place in the traditional life-support courses.
There is change afoot however. ACLS is emphasizing a C-A-B approach with more emphasis on early and continuous chest compressions and less on advanced airway management, especially in the field.
Similarly, for trauma, we must change our approach. We have the benefit of learning from our military colleagues and advancing our own civilian practice to what makes physiologic sense – if you attempt to perform an RSI on an under-resuscitated patient who is still actively bleeding, the chance of them suffering post-intubation hypotension and arrest is extremely high.
What should I do?
Change the “ABC” approach to the “CCAB” approach.
This approach makes more pathophysiologic sense and directs team efforts to that which needs to be addressed first to make the next step safer.
Importantly, even a threatened airway can be managed with good basic airway maneuvers until the first C’s have been addressed.