the cardiovascular system, and arranging for definitive therapy (which usually involves rapid transfer to a trauma center).
Triage The main objective of triage is to put patients in categories according to their chance of survival. The vital signs are assessed along with the patient’s mechanism of injury, age, and suspected underlying medical conditions. Evidence that a faster workup is necessary include having multiple injuries, being extremely young or quite elderly, having severe neurological trauma, having an instability of the vital signs, having preexisting cardiac disease or having lung disease. The primary survey is performed first to identify those things that are life-threatening. Obstructed airway takes precedence over impaired circulation and things like the necessity of amputation or other organ injury. If possible, caregivers need to assess all body systems at the same time, while simultaneously correcting those things that are correctable. By evaluating and treating at the same time, patients with multiple traumatic injuries can be treated and stabilized faster. The need for a resuscitation team is labor intensive but is necessary in the trauma setting and in cases where there are mass casualties. When many victims are in need of care, the triage process allows for the maximal amount of care to be given to those patients who are expected to survive their injuries but that need intervention. In some cases, the most severely injured patients are not treated because they are not expected to survive even with maximal resuscitation. The resuscitation team needs to be organized as soon as it is deemed necessary to treat one or more traumatized patients. Leadership roles need to be established early and equipment needs to be operable. In larger hospitals, surgeons need to be notified and available to correct any surgicallycorrectable traumatic injuries. The team leader should be a physician skilled in the management of trauma patients. Other doctors or providers are designated to be responsible for the airway management, blood pressure control, and the secondary survey of the patient. If procedures need to be done, a healthcare provider skilled in that area needs to be available to provide the service. Nurses must be available for the continual monitoring of the vital signs, intravenous access, and the attainment of blood samples. If possible, respiratory therapists need to be on hand for airway management and x-ray services need to be available for radiologic studies. Neurosurgeons and orthopedic surgeons need to be contacted immediately as soon as it becomes evident they are needed. If there is severe CNS trauma, a neurosurgeon must be readily available to provide emergency neurosurgical intervention for patients with CNS trauma. The first step in trauma care is the performance of a primary survey. It involves an evaluation of the airway, breathing, circulation, disability, and environmental exposure. The first priority is airway. This is assessed by determining the ability of environmental air to enter lungs that are unobstructed. Obstruction of the airway can be due to direct injury to the pharynx or larynx, foreign bodies inside the airway, edema, or an inability of the individual to protect their airway because of a decreased level of consciousness. Treatment of airway disturbances can be done by removing excretions using suction or by intubating the patient. If facial trauma is present, the patient can have a surgical airway placed.
6
