Updates in Emergency Department Trauma Management: A Narrative Review

Traumatic injury remains a major global cause of death and disability, with uncontrolled hemorrhage continuing to represent one of the leading causes of early preventable death after trauma. This narrative review summarizes current evidence-based updates in emergency department (ED) trauma management. The primary survey algorithm has been revised to "x-ABCDE," placing immediate hemorrhage control before airway assessment. Aggressive crystalloid resuscitation has been replaced by damage control resuscitation (DCR) using low-titer O-negative whole blood (LTOWB) or balanced 1:1:1 component therapy. The Assessment of Blood Consumption (ABC) score is recommended to guide activation of the massive transfusion protocol (MTP). Pediatric fluid limits are now strictly defined by weight. Video laryngoscopy (VL) should be considered the default first-attempt device in most critically ill ED trauma patients when visualization is not severely compromised. Pre-intubation hemodynamic optimization is essential to prevent cardiovascular collapse during intubation. Permissive hypotension is contraindicated in traumatic brain injury (TBI) and spinal cord injury (SCI), with a target systolic blood pressure (SBP) ≥ 100–110 mmHg. Tranexamic acid (TXA) given within three hours reduces TBI-related mortality. Universal cervical immobilization has shifted to selective spinal motion restriction (SMR). Structured communication tools, Trauma-Informed Care (TIC), and the Zero and Quaternary Surveys have been incorporated into routine trauma practice. Together, these changes move trauma care from volume-driven resuscitation toward physiology-guided and patient-centered approaches.