218 Surgical Emergencies
MULTIPLE INJURIES
OVERVIEW
The management of every severely injured patient requires a coordinated
approach, such as that taught in Advanced Trauma Life Support (ATLS™,
American College of Surgeons) and the equivalent Early Management of Severe
Trau ma (EMST™, Royal Australasian College of Surgeons) courses.This involves a rapid primary survey, resuscitation of vital functions, a detailed
secondary survey and the initiation of definitive care.
1 Primary survey
Rapid patient assessment to identify life-threatening conditions and establish
immediate priorities.
2 Resuscitation phase
Optimizes the patient’s respiratory and circulatory status. The response to
resuscitation is recorded with comprehensive non-invasive monitoring.
(i) Once resuscitation is under way, a trauma series of X-rays is
taken, bloods are sent, and additional procedures such as a
rapid bedside ultrasound, nasogastric tube insertion and urinary
catheterization are performed.
3 Secondary survey
Commences after the primary survey is complete and the resuscitation phase
well under way:
(i) A detailed head-to-toe examination is made.
(ii) Special X-rays, repeat ultrasound, computed tomography (CT)
scan and angiographic studies are performed as indicated.
4 Definitive care
Management of all the injuries identified, including surgery, fracture stabiliza-
tion, hospital admission or preparation of the patient for transfer, if required.
5 Expect serious injuries in patients presenting with altered physiology, or
after the following high-risk mechanisms:
(i) Abnormal vital signs: systolic blood pressure <90 mmHg,
Glasgow Coma Scale (GCS) score ≤12, respiratory rate <10/min
or >30/min.
(ii) Motorcyclist or pedestrian struck.
(iii) Fall >5 m (15 ft).
(iv) Entrapment.
(v) High-speed impact, ejection or death of another vehicle
occupant.
6 Call senior Emergency Department (ED) staff immediately for any multiple-
i nju r y pat ient, to orga ni ze a n i nteg rated tea m response i ncor porat i ng a naes-
thetic, intensive care, surgical and orthopaedic colleagues.