Initial care of the patient with blunt polytrauma

The initial care of the patient with blunt polytrauma involves a systematic search for causes of hemodynamic instability. Bleeding most often occurs in the pleural space, peritoneal cavity, and retroperitoneum. Orthopaedic injuries also can contribute to instability after blunt trauma. Blood loss from open fractures may be substantial, and exposure with direct vessel control should be performed early. Pelvic fractures can be associated with severe retroperitoneal bleeding. The treatment of patients with complex pelvic fractures includes closing the pelvic space with a binding device, and early pelvic angiography with embolization. Care of patients with multiple organ and bone injuries requires coordination by one trauma team leader. This physician oversees the resuscitation and sets treatment priorities, including the type and amount of time allowed for fracture stabilization. In many cases, nonorthopaedic injuries will need to be addressed before definitive fracture care. However, optimal care typically involves a coordinated multispeciality approach that sometimes includes concurrent operative procedures. Patients with severe physiologic derangements may require damage control techniques to decrease blood loss and operative time. Understanding the overall care of patients who are injured critically will facilitate the integration of the orthopaedic surgeon into the trauma team.