A - Airway with cervical spine protection:

• Use jaw thrust to open the airway (avoid chin lift)
• If the airway is compromised, secure with an endotracheal tube
• Protect the cervical spine with in-line immobilisation and jaw thrust

B - Breathing:

• Provide ventilatory support and identify life-threatening injuries:
• Haemothorax
• Pneumothorax either tension or open
• Lung contusion/flail chest
• Tension pneumothorax requires immediate needle decompression
• A definitive chest drain is required for haemo- and pneumothorax
• Intubation and ventilation may be required before the child decompensates

C - Circulation with haemorrhage control:

• Control of catastrophic external bleeding comes before A and B
• Compress bleeding points with direct pressure
• Identify internal bleeding:
  • X-rays, ultrasound
  • Surgical opinion

D - Disability

• Assess and record neurology
• AVPU
• Identify signs of life-threatening head injury (e.g. unequal pupils)
• Prevent secondary injury - constant attention to ABC

E - Exposure:

• Expose the child fully to identify all injuries
• Look at the whole child
• Keep warm; keep covered after examination