Although patients with recently sustained traumatic injuries may present at any health care setting, this review focuses on resuscitation, stabilization, and management of the trauma patient in the emergency department. Patients with potentially severe traumatic injury often present to local, community hospitals and may require transfer to a trauma center after evaluation. Nevertheless, as long as it does not delay transfer unnecessarily, the initial evaluation can be undertaken in any setting. This review discusses assessment and stabilization, including triage and preparation, trauma team management, bedside evaluation, and supportive care and empirical therapy; diagnosis, including secondary evaluation and management, laboratory testing, and additional imaging following the secondary evaluation; treatment and disposition; and outcomes. Tables describe advanced trauma life support primary evaluation, the Glasgow Coma Scale, National Emergency X-Radiography Utilization Study low-risk criteria, criteria for a positive diagnostic peritoneal lavage, bedside airway tools and rescue airway devices, and difficult airway predictors. Figures include an illustration showing immobilization of the cervical spine, a computed tomographic scan of an open book pelvic fracture, left-sided traumatic hemothorax, focused abdominal sonography for trauma examination, and the appropriate intercostal spaces of needle insertion.
This review contains 5 highly rendered figures, 6 tables, and 115 references.
ATLS®: breaking new ground