Resuscitation and evaluation of victims of blunt multisystem trauma

The initial management of hemodynamically unstable polytrauma patients can be challenging. Although there are other possible causes of hypotension, such as tension pneumothorax, CNS injury and hemopericardium, in the vast majority of blunt trauma victims shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clearcut, the rapid identification and control of the bleeding source may not be a straightforward matter. Such patients often have injuries to several body systems and thus have numerous potential sites of hemorrhage. Ideally, the injury pattern should be defined during resuscitation. The use of a trauma team and standardized protocols facilitate patient management. Clearly, airway patency and adequacy of ventilation must have top priority. Cervical spine immobilization should be maintained until a fracture has been ruled out. In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. In unstable patients the potential need for urgent surgical intervention must not be overlooked.