[Management of the unstable patient with multiple trauma]

The management of the patient with multiple trauma in unstable condition must be adapted to the means available (or unavailable) on site, i.e., trained personnel, material means, and the possibility of evacuation to a trauma center. This may require a multi-stage surgical strategy based on clinical examination and available imaging resources. Patients with multiple trauma in unstable condition should be brought to the operating room promptly for life-saving or stabilizing interventions (Extreme Urgency). The patient may then undergo further stabilization of vascular volume, coagulation, and metabolic deficits while simultaneously undergoing a more detailed clinical and radiologic evaluation; he may then return to the operating room within six hours for more definitive repair of urgent lesions (First Urgency). Once the patient is stable enough for evacuation, he should be transferred to a trauma center for definitive surgical care.