Initial Assessment and Resuscitation of the Trauma Patient

Abstract

Optimal trauma care requires the effective deployment and coordination or a variety of resources and specialists across several functional areas of the acute care hospital; it is organized around the distinct phases of prearrival preparation and organization, as well as the primary, secondary, and tertiary surveys. The trauma team leader must organize the tasks of evaluation and resuscitation in parallel, recognize and immediately address potentially life-threatening conditions, and move the patient toward definitive therapy in the most timely fashion. Using the concepts of initial airway, breathing, circulation, disability, and exposure assessment, the secondary systematic head-to-toe evaluation, and adjunct tools such as the focused assessment with sonography in trauma, plain film radiography, and computed tomography, all injuries must be diagnosed, prioritized, and managed. The concepts of damage control, coordinated care, and prevention of secondary injury emphasize the importance of ongoing reassessment and resuscitation. Established guidelines aid with the severity classification of shock, volume, and blood product resuscitation, as well as specific measures for commonly encountered potentially life-threatening injuries. Optimal trauma management must also take into consideration the unique anatomic and physiologic conditions and needs of special populations, such as children, pregnant patients, geriatric, and morbidly obese patients.