Management of life-threatening trauma

The response to major traumatic injury is a clinical challenge for even a well-trained hospital team. Efficient, effective treatment must be initiated as life-threatening problems are identified, often without the benefit of a definitive diagnosis. Therapy focuses on maximizing oxygen delivery and oxygen utilization in a hypermetabolic patient by improving gas exchange and blood flow. An algorithmic approach to patient care during a fast-paced, high-stress resuscitation is known to optimize this therapy and to improve outcome. Even with their proven benefit in facilitating patient care, algorithms have inherent limitations that require attention and common sense on the part of the attending clinician. It is true that "trauma can take you anywhere" and even a minor injury, especially if improperly managed, can lead to life-threatening complications and death. No algorithm can include all of trauma and all the possible sequelae without being too difficult for practical application. The algorithms cannot include basic common sense, which, right or wrong, is assumed to be a part of each doctor's decision-making skills. The algorithms are inherently in series, whereas emergency patient care requires the management of complex problems in parallel. The clinician is required to understand the priorities outlined in the algorithms, to have the skill to identify life-threatening problems, to use the appropriate protocol, and to move forward or backward in the protocol when the patient's condition demands a change of focus and priority. The algorithms enhance but are not a substitute for up-to-date medical knowledge, familiarity with anatomy, good clinical skills, and experience. Finally, although these algorithms are based on years of clinical experience, they have not been tested with the appropriate prospective clinical studies needed to generate veterinary outcome statistics. Future modifications in algorithm protocol will be based on such studies.