The initial evaluation of the multiple trauma patient

The primary evaluation and resuscitation of the multiple trauma patient is based upon diagnosis and therapy of the failures of oxygen transport. The sequence is clearly ventilation, circulatory failure, and pulmonary failure. The secondary evaluation is related to intracranial, intrathoracic, intra-abdominal, and extremity injuries. These 2 phases overlap. Thus, ventilation needs to be achieved without further compromise of spinal cord function while the control of external bleeding certainly aids circulatory function. In addition, effective cardiopulmonary resuscitation commonly greatly improves cerebral function. Thus, although discussed separately, evaluation and resuscitation is a complex endeavor that involves all of the injuries and all of the organs on a varying time scale in which the failures of oxygen transport are of first order importance because of the time scale that leads to death. Effective resuscitation demands a detailed knowledge of cardiopulmonary physiology and an aggressive personality so that the various possible mechanisms are evaluated and treatment is rapidly initiated. In general, the patient should have good cardiopulmonary resuscitation prior to being transferred to the radiographic unit. Thus, chest tubes may be placed on the basis of emergency room physical evaluation. The various pump failures are recognized by the failure of adequate circulatory response to blood volume support, usually accompanied by a rising right atrial pressure. Intra-abdominal and intrathoracic bleeding are largely diagnosed by chest or peritoneal lavage tubes without x-ray examination.