Damage Control: Advances in Trauma Resuscitation

Amal Mattu, MD, Consulting Editor

When I began emergency medicine training, trauma care was considered exciting and “sexy” to my colleagues and me. There was excitement with every case, and opportunities to gain experience in procedures abounded. However, as we gained experience in trauma resuscitation, my colleagues and I discovered that trauma care was actually fairly “cookbook.” Every patient was managed similarly…the A-B-Cs were employed religiously, with a low threshold for early intubation of any patient that was even mildly sick. C-spine, chest, and pelvis radiographs were obtained in nearly all patients; everybody was boarded and collared, and we routinely cut everyone’s clothes off. If the patient had a penetrating wound to “the box” (torso from the pelvis to the clavicles), the patient would go to the operating room (OR), and if the patient had blunt trauma and was stable, we’d send the patient to get computerized tomography of pretty much everything…and the radiologist would give us the diagnosis. Management of these patients became somewhat boring, actually, as there was very little thought to the workup.

However, trauma care has changed markedly. The rote practice of A-B-C and the traditional Advanced Trauma Life Support course have changed, and clinical decision making is routinely incorporated into management decisions. Airway management has advanced far beyond the routine intubation of so many patients. Nonoperative management of many conditions that used to routinely go to the OR is common. Trauma has largely become a nonsurgical condition requiring more thought than ever before. Although once considered the domain of the surgeon, care of the trauma patient is now clearly recognized as a multidisciplinary responsibility, and emergency physicians are playing a leading role.

In this issue of Emergency Medicine Clinics of North America , Guest Editors Drs Christopher Hicks and Andrew Petrosoniak have assembled an outstanding group of emergency care providers to bring you the latest in emergency medicine knowledge regarding the care of trauma patients. A comprehensive approach is taken beginning with an important discussion of how to optimize teamwork in caring for trauma patients. Traumatic arrest is discussed, including the latest evidence for thoracotomy. Next, a top-down approach to care of these patients is provided, including discussions of care of patients with brain injury, thoracic injuries, abdominal and pelvic injuries, and vascular injuries. Separate articles are provided focusing on patients at the extremes of age. Finally, a critically important article is provided that discusses care of the patient in the community, non-trauma-center setting.

This issue of Emergency Medicine Clinics of North America represents an important addition to the emergency medicine literature. Drs Hicks and Petrosoniak and their colleagues have provided a cutting-edge update of the current knowledge of emergency trauma care. Emergency physicians in every type of practice setting will find this issue immensely useful for the daily care of trauma patients, and it will undoubtedly improve the care of those patients. This issue also nicely exemplifies how far our specialty has progressed in trauma care beyond the basics of “A-B-C.” Kudos to the contributors for an outstanding issue!

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