Initial resuscitation and assessment of patients with multisystem blunt trauma

In the vast majority of blunt trauma victims, shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clear-cut, the rapid identification and control of the bleeding source may not be. Such patients often have injuries to several body systems and thus have numerous possible sources of hemorrhage. Ideally, the injury pattern should be defined during resuscitation, preferably by a trauma team using standardized protocols. Airway patency and adequacy of ventilation have top priority. The cervical spine must be immobilized until 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. Patients in unstable condition may need emergency surgery.