The management of severely injured patients can be complex and requires a familiarity
with a large body of clinical information that encompasses several specialties. Thus,
organized trauma systems with designated trauma centers and trauma specialists have
proven valuable for managing the multiply injured patient [
1
,
2
]. Unfortunately, only 35 states have formal trauma systems [
[3]
]. Critical care of the severely injured patient may therefore, at many centers, fall
to other critical care physicians. This article discusses the prehospital and initial
management steps of the multiply injured patient, focusing on established principles
of therapy with which a critical care specialist should be familiar.To read this article in full you will need to make a payment
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References
- Systematic review of published evidence regarding trauma system effectiveness.J Trauma. 1999; 47: S25-S33
- Preferential benefit of implementation of a statewide trauma system in one of two adjacent states [discussion].J Trauma. 1998; 44: 609-617
- National inventory of hospital trauma centers.JAMA. 2003; 289: 1515-1522
- 2001 National hospital discharge survey. National Center for Health Statistics, Hyattsville (MD)2003
- Deaths: leading causes for 2000. National Vital Statistics Reports, Hyattsville (MD)2002
- Traffic Safety Facts 2001. National Center for Statistics & Analysis, Washington (DC)2001
- Report of the Trauma Service. Oregon Health & Science University, Washington (DC)2002
- Practice management guidelines for geriatric trauma: the EAST practice management guidelines work group.J Trauma. 2003; 54: 391-416
- A comparison of EMT judgment and prehospital trauma triage.J Trauma. 1991; 31: 1369-1375
- Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state.J Trauma. 2003; 54: 663-669
- Paramedic vs private transportation of trauma patients. Effect on outcome.Arch Surg. 1996; 131: 133-138
- Prehospital cardiopulmonary resuscitation of the critically injured patient.Am J Surg. 1984; 148: 20-26
- Prehospital endotracheal intubation: rationale for training emergency medical personnel.Ann Emerg Med. 1985; 14: 1085-1092
- The effect of a quality improvement program on paramedic on-scene times for patients with penetrating trauma.Acad Emerg Med. 1999; 6: 191-195
- Effect of prehospital advanced life support on outcomes of major trauma patients.J Trauma. 2000; 48: 643-648
- Prospective MAST study in 911 patients.J Trauma. 1989; 29: 1104-1111
- Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury.J Trauma. 2003; 54: 307-311
- The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury.J Trauma. 2003; 54: 444-453
- Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: a preliminary report.J Trauma. 1992; 33: 354-361
- Advanced trauma life support for doctors. The American College of Surgeons, Chicago (IL)1997
- Airway management in patients with unstable cervical spine fractures.Ann Emerg Med. 1989; 18: 1237-1239
- Oral intubation in the multiply injured patient: the risk of exacerbating spinal cord damage.Ann Emerg Med. 1990; 19: 511-514
- Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation.Ann Emerg Med. 2000; 36: 293-300
- Airway management in the blunt trauma patient: how important is the cervical spine?.Can J Surg. 1992; 35: 27-30
- Comparison of two cricothyrotomy techniques: standard method versus rapid four-step technique.Ann Emerg Med. 1998; 32: 442-446
- Treatment dilemmas in laryngotracheal trauma.J Trauma. 1988; 28: 1439-1444
- Blunt laryngeal trauma: classification and management protocol.J Trauma. 1990; 30: 87-92
- Does tachycardia correlate with hypotension after trauma?.J Am Coll Surg. 2003; 196: 679-684
- Base defect does not predict mortality when secondary to hyperchloremic acidosis.Shock. 2003; 17: 459-462
- Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multi-center Trial.Ann Surg. 1991; 213: 482-491
- Hypertonic saline–dextran solutions for the prehospital management of traumatic hypotension [discussion].Am J Surg. 1989; 157: 528-534
- Survival after emergency department thoracotomy: review of published data from the past 25 years.J Am Coll Surg. 2000; 190: 288-298
- Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial.J Neurosurg. 1991; 75: 731-739
- Mannitol in acute traumatic brain injury.Lancet. 2002; 359: 1633-1634
- Use of mannitol.J Neurotrauma. 2000; 17: 521-525
- Not so fast.J Trauma. 2003; 54: 52-59
- Rib fractures in the elderly.J Trauma. 2000; 48: 1040-1046
- A step-wise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia.J Trauma. 1990; 30: 799-804
- Implementation of a trauma survey decreases missed injuries.J Trauma. 2003; 54: 38-43
- Mechanism of acute ascites formation after trauma resuscitation.Arch Surg. 2003; 138: 773-776
- Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion.Am J Surg. 1990; 160: 515-518
- Massive transfusion exceeding 50 units of blood products in trauma patients [discussion].J Trauma. 2002; 53: 291-296
- Coagulopathies in trauma patients.AACN Clin Issues. 2002; 13: 192-203
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
