An approach to the initial assessment of trauma

Abstract Ambulance services communicate with trauma clinicians by providing information on the mechanism of trauma, injuries noted, clinical signs, and treatment initiated. The early management of trauma is time-critical. Consequently, attention is first directed at ensuring a patent airway, with cervical spine protection, and at controlling life-threatening haemorrhage. Subsequent priorities are: ensuring satisfactory breathing and ventilation; haemorrhage control; assessment of neurological status; and control of environment (avoiding hypothermia) and exposure. Inability to breathe can be caused by flail chest, pneumothorax, haemothorax, and massive pulmonary contusion. Optimization of ventilation and circulation prevents avoidable secondary brain injury. Trauma systems and triage protocols improve outcomes. Children have specific anatomical and physiological features that influence the initial assessment, resuscitation, and subsequent definitive management. The possibility of non-accidental injury must be considered where there is delay in presentation, an inconsistent history, or unusual injuries. Areas of controversy in paediatric trauma relate to the place of minimal fluid resuscitation for penetrating trauma, use of crystalloids, massive transfusion protocols, use of tourniquets, options for managing tension pneumothorax, role of angiography for pelvic trauma, and use of neck collars and spinal boards for suspected neck injuries.