The trauma emergency room: a concept for handling and imaging the polytrauma patient

Polytrauma is a life-threatening entity that requires immediate action by all specialties involved. Upon arrival in the hospital, the patient will be seen and managed primarily by three groups of medical personnel: (a) surgeons (trauma specialists), (b) intensive care specialists, and (c) radiologists. The usual medical approach within the first minutes to hours will consist of four important steps: (1) primary survey, (2) resuscitation and stabilization, (3) secondary survey, and (4) definitive care. Survey, with regard to polytrauma, means quick and comprehensive evaluation of the patient's situation, clinically as well as by imaging. To fulfill these requirements, an interdisciplinary trauma emergency room with appropriate equipment, infrastructure and environment is necessary. Immediately after the patient's arrival and within a short time span, a limited number of plain radiographs of the spine, chest, pelvis, and abdomen (and extremities and skull, if necessary) should be obtained without turning, moving, or repositioning the patient. Sonography will be applied simultaneously to visualize or exclude: free fluid collections within the pleural spaces and/or peritoneal cavity and in other compartments (retroperitoneum, pelvis, soft tissues). Organ lesions (such as lacerations of liver, spleen or kidneys) and posttraumatic pathology of large vessels (tears, occlusion, aneurysm) can be evaluated or detected by sonography. These basic imaging studies (plain films and sonography) together with the clinical findings may be conclusive, or at least serve as decision makers for further action which may include: (a) more detailed plain radiography examinations, (b) tailored computed tomography examinations, invasive/interventional procedures (angiography or image-guided punctures), or (c) immediate surgical intervention. This concept is a challenge for the medical groups involved. Unlimited interdisciplinary cooperation and mutual exchange of information are the fundamental principles for successful trauma care and management.