[Management of multiple trauma in the emergency room]

The management of multiple trauma patient in the emergency room is paradoxical because the treatment must be performed as soon as possible, but the precise diagnosis using imaging is time consuming. Multiple trauma might be classified into 3 classes. Patient in class 1 is severely injured with serious neurological, respiratory and/or hemodynamic distress. Imaging procedures only consist on chest x-ray, abdominal ultrasonography and echocardiography if needed, while saving treatments are immediately required such as tracheal intubation and mechanical ventilation in case of severe brain trauma or acute respiratory failure, chest tubing in case of massive pleural effusion, surgery for hemostasis. Class 2 is represented by a patient who is seriously injured but quite stabilized by intensive care such as massive vascular loading. The aim of clinical examination is to choose specific imaging to detect and to treat potential lethal injuries such as abdominal US, chest x-ray (4 views), angiography for embolisation, brain CT scan. Class 3 patient is stabilized because of medical management on the field by MICU (SAMU/SMUR). The best management is to first perform total body CT scan to obtain quick and precise diagnosis of injury and to organize specific imaging procedure or specific surgery. In conclusion, the best management of multiple trauma implies trained medical and paramedical staff including emergency physicians and anesthesiologists in the hospital but also in the fields, efficient medical dispatching to transport the patient in the hospital able to immediately manage the patient, surgeons of several specialties, radiologist. Indeed, the aim is not to transport as quick as possible the patient in the nearest center, but to have a logical strategy in order to have the quickest discharge with the least sequellae as possible.