Principles of trauma management

Trauma is a surgical disease that results in more than 5 million deaths worldwide each year. In the United States, standardized management principles have evolved to address variations in processes of care to improve the outcomes of traumatized patients. The American College of Surgeons developed the Advanced Trauma Life Support (ATLS) and tiered levels of trauma care to improve trauma outcomes across the United States. In many settings, surgeons and emergency medicine physicians participate in the initial workup of trauma patients. The principle of the golden hour refers to the limited time available to intervene effectively to salvage life and limb. The golden hour calls for the immediate prioritization and management of the trauma patient according to ATLS principles. The ABCDE mnemonic was developed to enforce prioritization in trauma management in descending order of importance: Airway and cervical spine protection Breathing Circulation and hemorrhage control Disability and neurologic status Exposure and environmental aspects ATLS outlines the fundamental management concepts of the trauma patient: Treat injuries that have the greatest risk to life first. Lack of definitive diagnosis should never impede the application of an indicated treatment. A detailed history is not essential in the evaluation and treatment of the injured patient. We will review the components of the primary survey in the evaluation of the trauma patient, focusing on what an anesthesiologist should know.