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This review article reminds us that circulation needs to be prioritized over airway in trauma patients. This means bleeding control (pressure on wound, tourniquet, surgery/IR intervention), correcting tension pneumothorax, correcting pericardial tamponade, as well as resuscitation to return physiologic homeostasis (blood products, vasopressors where needed, warm the patient, etc.) before intubation. Altered mental status/low GCS may be due more to hypoperfusion than neurologic injury. Correcting the hypotension may alleviate that need to intubate.
References
Ferrada, Paula MD, FACS, FCCM, MAMSE; Duchesne, Juan MD, FACS, FCCM, FCCP; Piehl, Mark MD, MPH. Prioritizing circulation over airway in trauma patients with exsanguinating injuries: What you need to know. Journal of Trauma and Acute Care Surgery 99(5):p 679-683, November 2025. | DOI: 10.1097/TA.0000000000004618