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Trauma care should be guided by the concepts of rapid assessment, triage, resuscitation, serial reassessment, diagnosis, and therapeutic intervention.
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Trauma patients can sustain a multitude of injuries. Many will present with abnormal vital signs, neurologic deficits, or other gross evidence of injury. These signs must prompt both a thorough search for the specific underlying injuries and rapid interventions to correct the abnormalities. Nonspecific signs such as tachycardia, tachypnea, or mild alterations in consciousness must similarly be presumed to signify serious injury until proven otherwise. Further, without signs of significant trauma, the mechanism of injury may suggest potential problems, and these also should be pursued diligently.
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The assessment of trauma patients begins with a focused history from the patient, family members, witnesses, or prehospital providers. Patterns of injuries, and expected physiologic responses to these injuries, can be ascertained by collecting history regarding the circumstances of the event (eg, single vehicle crash, fall from height, smoke inhalation, or environmental exposures), ingestion of intoxicants, preexisting medical conditions, and medications.
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To facilitate an organized approach to the trauma patient, the examination is divided into primary and secondary surveys (Table 156-1). The goal of the primary survey is to identify and immediately treat life-threatening conditions. To do so, the acronym ABCDE encourages the clinician to examine the patient's airway, breathing, circulation, and disability (mental status, Glasgow Coma Scale (GCS), and neurologic examination), and to completely expose each patient so that occult injuries or exposures are visualized. After this initial primary survey, perform a thorough head-to-toe examination (the secondary survey, Table 156-1), then proceed with appropriate diagnostic testing and further therapeutic interventions.
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