Initial assessment of the polytrauma patient

Trauma is the leading cause of death among those aged less than 50 years in the UK. This article highlights the management principles for treating the multiply injured patient, based on the algorithm devised by the American College of Surgeons Committee on Trauma called the Advanced Trauma and Life Support® guidelines. These guidelines focus on the ABCDE approach, which stands for Airway and cervical spine control, Breathing, Circulation, Disability/neurological status and Exposure. The algorithm was devised to create a common structured approach to managing any patient involved in trauma. It also ensures that life-threatening injuries are identified and treated first before moving on to treat limb-threatening injuries. The final aim is to identify all the injuries. The principles of treating the multiply injured can be divided into four phases: primary survey (ABCDE) and resuscitation, re-evaluation, secondary survey (full head-to-toe examination) and transfer to definitive care. Using these principles, problems are identified and addressed in a stepwise manner from A (airway) to E (exposure), followed by re-evaluation and the secondary survey in a sequence that allows all injuries to be identified. However, should the patient’s condition deteriorate, the attending team must restart the primary survey at A (airway) once again.