TRAUMA - INITIAL MANAGEMENT The initial management of the severely injured patient requires the surgeon to make rapid choices between various diagnostic and therapeutic interventions. In patients with a single severe injury there is a single set of priorities. In sharp contrast, a patient with critical injuries to several different organ systems often presents conflicting priorities in management. The thoughtful and accurate ordering of diagnostic and therapeutic interventions is critical to provide the optimal outcome and is perhaps the most important task of the trauma surgeon.[13] Priorities in Initial Management It is essential to begin with the assumption that the physiologic state of the patient is likely to deteriorate, perhaps abruptly, and that there is more than one serious injury present. It is also essential to realize that the most obvious or most dramatic injury may not be the most critical one. The trauma surgeon must adopt a very focused approach in which problems are addressed in strict order of their threat to life and function. Even a small delay for the treatment of a more minor injury cannot be tolerated. Within this focused approach, the surgeon must be constantly reassessing the situation as new data are obtained and be able to instantly change the focus and the order of priorities as new injuries or new findings are brought to light. The necessity to balance various conflicting priorities and accurately direct the initial diagnosis and treatment requires an approach to the patient as a whole, not as isolated organ systems. The overall management of the patient is best directed by one person who has the experience and authority to make difficult immediate decisions under stressful circumstances.
Posted on: Wed, 29 Jan 2014 10:59:13 +0000
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