title: The initial management of severe trauma patients at hospital admission.
abstract: The initial management of trauma patient is a critical period aiming at: stabilizing the vital functions; following a rigorous injury assessment; defining a therapeutic strategy. This management has to be organized to minimize loss of time that would be deleterious for the patients outcome. Thus, before patient arrival, the trauma team alert should lead to the initiation of care procedures adapted to the announced severity of the patient. Moreover, each individual should know its role in advance and the team should be managed by only one individual (the trauma leader) to avoid conflicts of decision. A rapid trauma injury assessment aims not only at guiding resuscitation (chest drainage, pelvic contention, to define the mean arterial pressure goal) but also to decide a critical intervention in case of hemodynamic instability (laparotomy, thoracotomy, arterial embolisation). This initial assessment includes a chest and a pelvic X-ray, abdominal ultrasound (extended to the lung) and transcranial Doppler (TCD). The whole body scanner with administration of intravenous contrast material is the cornerstone of the injury assessment but can be done for patients stabilized after the initial resuscitation.
authors.affiliation: Département d'anesthésie-réanimation chirurgicale, université Paris-Sud, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, Assistance publique-Hôpitaux de Paris, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. anatole.harrois@bct.aphp.fr
authors.forename: A
authors.initials: A
authors.lastname: Harrois
authors.forename: S
authors.initials: S
authors.lastname: Hamada
authors.forename: C
authors.initials: C
authors.lastname: Laplace
authors.forename: J
authors.initials: J
authors.lastname: Duranteau
authors.forename: B
authors.initials: B
authors.lastname: Vigué
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D006470:Hemorrhage / Q000150:complications / Q000628:therapy; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D010343:Patient Admission; D010348:Patient Care Team; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Evaluation; Multiple trauma; Quality; Qualité; Traumatisme; Évaluation