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KEY POINTS

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  • Therapeutic intervention in the multiply injured patient must be prioritized to maximize survival.

  • The degree of life threat posed by the alteration in physiology from each injury determines the order of priority.

  • Immediate priority is given to airway control and to maintenance of ventilation, oxygenation, and perfusion.

  • Cervical spine protection is crucial during airway assessment and manipulation.

  • When several personnel are involved, a trauma team leader is important to coordinate management in the multiply injured patient.

  • Safe effective techniques for airway control, chest decompression, and the establishment of intravenous access are key skills in management of multiple trauma.

  • After immediately life-threatening abnormalities have been corrected, systematic anatomic assessment is required to identify and manage other injuries.

  • Repeated assessment is necessary to identify changes in the patient’s status and institute appropriate treatment.

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Although the institution of trauma systems has altered the pattern of mortality distribution following multiple injuries,1 it is still useful to consider the trimodal distribution pattern.2,3 The first peak of this trimodal distribution represents deaths occurring at the scene and results from such injuries as cardiac rupture or disruption of the major intrathoracic vessels, and severe brain injury that is incompatible with survival. Death from such injuries occurs within minutes of the traumatic event and medical intervention is usually futile. The second peak in mortality following multiple injuries occurs minutes to a few hours after the event. Mortality during this phase is related to injuries that are immediately life-threatening, such as airway compromise, tension pneumothorax, and cardiac tamponade. However, simple appropriate resuscitative measures can significantly affect the outcome during this phase. The third peak occurs as a result of complications of the injury, such as sepsis or multiorgan failure.3 However, mortality in this third phase can also be significantly altered by the type of intervention during the second phase. The intensivist dealing with the multiple trauma patient is very likely to be involved in the institution of resuscitative measures during the second phase as well as the management during the third phase of the complications of the injury or complications arising from inadequate treatment. Many of the chapters in this text deal with the complications of trauma, such as sepsis and multiple organ failure. This chapter will emphasize treatment priorities during the second peak of the trimodal distribution of trauma-related mortality.

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Blunt trauma from motor vehicle collision is the most frequent cause of injuries in general. This type of impact usually results in injuries to many different parts of the body simultaneously. Such a patient may present with head and neck injuries as well as abdominal and extremity injuries.

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When faced with multisystem injury, the intensivist must prioritize treatment according to the threat to the patient’s survival.4 Prioritization of assessment and intervention requires a coordinated team approach. Where personnel are available from different specialties, it is of paramount importance that the entire resuscitative effort be ...

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