[Initial evaluation and treatment, selection by priority].

Abstract

Mortality from severe multitrauma is 25-30%. Haemorrhage is the cause of one third of the deaths, either directly or indirectly as the cause of organ failure. Many trauma victims will not present alarming symptoms shortly after the accident. When high energy trauma is suspected the patient should be admitted to a resource hospital with the relevant expertise for systematic evaluation. Control over the airways and venous access should be obtained within minutes, and it should be established whether the patient is bleeding so much as to warrant emergency operation. The diagnostic work-up should have been completed within two to three hours. All severely injured patients should be treated initially at the same location, following the same routines. Due to risk of overlooking injuries, patients should not be sorted by surgical specialty in the field. Obstructed airways are more acutely life-threatening than inadequate respiration, which is more serious than decreased circulation, which is again more dangerous than impaired consciousness. In general, thoracic injuries take priority over abdominal, cerebral and orthopaedic injuries, in that order.