Surgical preparation of the trauma victim

Successful management of the victim of multisystem trauma depends on an orderly scheme of resuscitation and diagnostic evaluation. This management is directed by the general surgeon heading the trauma service. Based on his or her knowledge of the mechanisms of injury and the initial physical examination, the surgeon establishes priorities of treatment for the most life-threatening injuries. He directs the preoperative preparation, including communication with the operating room and anesthesia staffs, assembly of a basic laboratory profile, and placement of lines and tubes. The trauma surgeon identifies need for consultation in the medical or surgical specialties and formulates a strategy for surgical management with the consultants. Finally, based on his or her impression of the injuries and their relative severity, the surgeon selects the diagnostic tests, particularly peritoneal lavage, CT scan of the head and body, and arteriography, all of which will be needed to complete the surgical preparation.