Basic Principles of Trauma Care

The modern concept of initial trauma care focuses on the physiological derangements following severe trauma, rather than the specific injuries sustained by the patient. The first priority in the treatment of trauma patients is to establish airway patency, because obstructed upper airway will cause almost immediate hypoxia and respiratory acidosis. In contrast, certain lower extremity injuries are specifically associated with dangerous systemic effects. Every physician who takes care of trauma patients should be acquainted with these injuries and their management. All victims of blunt trauma undergoing urgent intubation should be regarded as having a cervical spine injury until proven otherwise. Preoxygenation should be performed in trauma patients prior to intubation. Cricothyroidotomy is the surgical airway of choice because it is simple, easy to perform, and relatively safe in the trauma setting. Tracheostomy may be required in patients with acute laryngeal trauma in whom placement of a tube through the cricothyroid may complicate existing laryngeal injury.