Emergency management of trauma practically begins prior to the arrival of the patient to the emergency room (ER). The emergency medical service (EMS) providers inform the emergency department about the mechanism of trauma and update them regarding the vital sign values, suspected injuries and first aid treatments provided to the patient. The emergency team is activated and the concerned specialties involved in the management of polytrauma patients are informed beforehand.

Trauma care should be guided by the following concepts of

  1. Rapid assessment
  2. Triage
  3. Resuscitation
  4. Serial reassessment
  5. Diagnosis and therapeutic intervention

To facilitate an organized approach to trauma patients, the examination is divided into the primary and secondary survey. The goal of the primary survey is to identify and immediately treat life-threatening conditions. To achieve efficiency, a universal acronym ABCDE is followed which helps the clinician to examine patients.

This includes Airway, Breathing, Circulation, Disability, and Exposure(to completely expose the patient so occult injuries are not missed). In the primary survey, life-threatening issues are identified and quickly addressed by intervention

Trauma code 

It is further activated after the patient arrives at the emergency department. Trauma code mainly consists of a team of specialists from various departments like Emergency, Anaesthesia, Gastro physicians, Gastro Surgeons, General Surgeons, Neurosurgeons, and Orthopaedics. 

Primary Survey ensures initial airway and neck spine stabilization. Airway management includes assessing for clearing and protecting the airway and performing endotracheal intubation for patients with a depressed level of consciousness.

The airway procedures are followed if there is significant bleeding for obstruction and also to permit air to pass freely to and from the lungs to ventilate the lungs. Management of breathing involves ventilating the patient with 100% oxygen, monitoring oxygen saturation level, inspecting for open chest wounds and abnormal chest wall motions.

Circulation 

This domain involves assessing blood volume loss and monitoring vitals like pulse rate, blood pressure and placing large bore Intravenous peripheral cannula for facilitation of beginning rapid infusion of intravenous fluids (crystalloid solution) and subsequently arranging for blood transfusion in the eventuality of severe blood loss.

Disability 

In this domain, the patient’s assessment involves screening neurological and mental status, to look for any limb weakness and to assess the level of consciousness (Coma scale). They also keep track of the blood glucose levels of the patient to avoid hypoglycemia.

Exposure involves completely exposing the patient and inspecting for injuries with log rolling the patient to inspect for any spine, back and flank injuries. Subsequent to the primary survey, the secondary survey involves head to toe examination for rapid identification of the injuries or potential instability. Secondary survey is performed for reassessing the unstable patient. 

They go through various scans such as sonography to detect any further complications. Once the primary and secondary assessments are completed the reports are reviewed by the respective specialists such as Neurosurgeons, Gastro surgeons for intra-abdominal bleeding, Orthopaedic assessment for bony injuries including a shattered pelvis. 

Emergency Patient Care

While the medical force is occupied in handling emergency patient care, the managers in emergency medicine play a significant role by liaising with patient’s family members, ensuring admission process, medico-legal aspects are handled efficiently in a professional manner.