Managing the trauma patient: critical decision making and when to call for help

Caring for the injured patient poses challenges to doctors of every grade but junior doctors can quickly contribute effectively and usefully to the management of the injured patient provided certain principles are followed. This paper seeks to set out some of these principles but is by no means exhaustive. Preparations necessary for the reception of injured patients centre around getting the right patient to the right doctor at the right time. Receiving hospitals should be well equipped and staff should have been trained along protocol guidelines such as Advanced Trauma Life Support (ATLSR) and a hospital trauma team should be established and functional. On arrival the injured patient is managed along ATLS-type guidelines with immediate assessment and treatment of life-threatening injuries. Once stabilized, a full evaluation of the patient can take place and selective investigation conducted. On occasion immediate surgery will be necessary but more commonly, plans can be made for prompt, but less dramatic, definitive care. It is well recognized that injured patients do not show all their injuries when they present and it is not infrequent for patients to deteriorate while undergoing investigation or on the ward subsequently. Thus there is a need for ongoing multidisciplinary care and for a high level of observation. The principles used for initial resuscitation can be extended to the ward-based phase of care. The complexities of trauma demand that every doctor involved has a low threshold for involving other specialists in the management of the patient in a prompt fashion. Conversely, it is important that one team take over all responsibility for the care of the patient and that other teams contribute proactively to the management plan.