Clinical assessment of major injuries

In the UK, trauma is the leading cause of death among individuals aged <50 years; it resulted in 3221 deaths and 281,000 injuries in the UK in 2004. This contribution highlights the management principles of treating multiply-injured patients. These principles are based on guidelines devised by the American College of Surgeons Committee on Trauma i.e. the Advanced Trauma and Life Support™(ATLS™) guidelines. These focus on the ABCDE (airway and C-spine control, breathing, circulation, disability/neurological status, exposure) approach. This management plan was devised to ensure that there is a common structured approach to managing trauma. It also ensures that the life-threatening injuries are identified and treated first before progressing to limb-threatening injuries; the final aim is to identify all injuries. The principles of treating the multiply-injured patient 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. Problems are identified and addressed in a stepwise manner from a to e, followed by re-evaluation and the secondary survey in a sequence that allows all injuries to be identified. The attending team must restart the primary survey at a once again if the condition deteriorates.