An approach to managing the multiply-injured patient

The incidence of trauma (both blunt and penetrating) is rising in the UK. Associated with significant morbidity and mortality, trauma is the commonest cause of death in the first four decades of life and mostly affects people in their third decade. Males are more likely to be injured than females. Death from trauma follows a tri-modal distribution where 50% of deaths occur at the time of trauma followed by another peak at an hour (golden hour) followed by a subsequent peak weeks or months later.

Trauma is frequently associated with multi-system injury. Such injuries may be difficult to identify and can be life threatening. The ‘Primary survey’ provides a simple and effective method for identifying and treating life-threatening injuries in the multiply-injured patient by treating the greatest threat to life first.

Assessment, investigation and treatment of the trauma patient are performed simultaneously. It may not be possible to take an accurate history until life-threatening problems have been addressed. Key information about mechanism of injury should be collected from paramedics who attended the scene. Several members of a ‘trauma team’ have specific roles using the same principles of trauma management under the guidance of an experienced Team Leader.

There are potential pitfalls with respect to the management of patients at the extremes of age, and pregnant women – this is because of altered physiology (senescent or iatrogenic).