The patient with multi-trauma can present a challenging case for a clinician.Damage to the respiratory system, cardiovascular
system, or neurologic system can all be fatal by themselves, and a combination of these injuries can present as a resuscitation
nightmare.
There are three intervals in which death may result from trauma.Deaths that occur within one hour following trauma are usually
from catastrophic, unsalvageable injury to the respiratory and cardiovascular system. The second interval occurs within 2-4
hours after trauma ("Golden Period").In these patients, prompt, aggressive treatment makes a difference in survival.The third
interval occurs 3-5 days following trauma, and deaths occur secondary to organ failure, sepsis, and unmasked injuries.
Plan for First Two Hours of Acute Care
Eliminate all immediate threats to life
Initial exam and resuscitation
Stabilization and re-evaluation
Once stable, definitive repair of injuries
Primary Survey: Evaluate for any immediate life-threatening injuries
The golden rule is to treat the most life-threatening problems first before assessing and treating for other injuries.Therapeutic
failures are generally not from ignorance but from failure to act expediently at a crucial moment.
During the primary survey, we start by evaluating our ABCD's—Airway, Breathing, Circulation, and Disability (nervous system).
Ensure the patient has patent airway with no obstructions.Evaluate the patient for severe dyspnea, restrictive breathing patterns,
and cyanosis.Evaluate for active, ongoing hemorrhage, mucous membrane pallor, poor pulse quality, or cold extremities.Evaluate
for intracranial or spinal injury leading to alterations in level of consciousness, paralysis, or loss of sensation.Based
on our findings from our primary survey, we will choose therapeutic options to remove immediate life-threatening problems.
