Early assessment of the acutely injured patient

The initial hour in the care of the victim of multiple injuries is the critical time for life and limb salvage. It is of utmost importance that the patient be under the supervision or direct care of a well coordinated team led by a traumatologist or at least a general surgeon familiar with the care of trauma patients. The most common cause of preventable death is failure of timely recognition of treatable injuries, because attention is diverted by more obvious but lower priority injuries. Specialty participation by urologist, orthopaedist, neurosurgeon, or other must be coordinated and must not take precedence over re-establishing the circulation, maintaining the airway, and generally caring for the ‘totally injured patient’. The initial period of care has been termed the ‘golden hour of trauma’, the time between injury and the onset of irreversible changes due to hypoxia and hypoperfusion. It is during this time that blood loss is controlled, fluid resuscitation is begun, multi-organ system injuries are diagnosed, and priorities for care are established.