Preparing the Trauma Patient for Surgery
Apr 14, 2025
🏥 Preparing the Trauma Patient for Surgery
Trauma patients are perhaps the most demanding patients of all, with several competing factors and an ever-changing, dynamic clinical picture that is time critical. ⏱️ Most networks will have some form of trauma response call 🚨 prior to the patient arriving in theatre, allowing some time for staff to prepare! 🧑⚕️👩⚕️
When preparing for a trauma patient, here are your top 5 considerations! ✋
🩺 Primary Survey and Resuscitation
📋 This follows the Advanced Trauma Life Support (ATLS) principles:
Airway
❤️ Breathing
🩸 Circulation
🧠 Disability
🧍♂️ Exposure (ABCDE)
⚠️ Immediate life-threatening issues must be addressed prior to transfer to the operating suite, with haemodynamic stability a priority, often requiring 💉 fluid resuscitation and 🩸 transfusion.
🖼️ Imaging and Diagnostics
🧾 Targeted imaging helps identify injuries needing surgical intervention. Standard trauma imaging includes:
📸 Chest and pelvic X-rays
🖲️ FAST (Focused Assessment with Sonography for Trauma)
🧠 CT scans
⏳ Timely and accurate imaging guides surgical planning and prevents missed injuries, however unless it pertains to surgery, it should not delay transfer to the operating suite.
🧠 Airway Protection and Cervical Spine Clearance
🗣️ Airway management is essential, particularly in patients with 🤕 altered consciousness or facial trauma.
🦴 Cervical spine injuries must be assumed in all trauma patients until proven otherwise.
📋 Clearance involves clinical assessment in alert patients without neck pain or neurological symptoms and sometimes imaging like a CT scan 🧠.
🛏️ The C-spine must remain immobilised until confirmed clear to prevent spinal cord injury 🧬.
📝 Definitive Diagnosis and Surgical Planning
🔍 Once life-threatening conditions are addressed and imaging is complete, the surgical team can determine the need for and timing of surgery ⏰.
🧪 This includes evaluating coagulopathy 🧬, organ dysfunction 🫀🫁, and the patient’s physiological status 🩺.
🗣️ Communication and Consent
🧑⚕️ Effective communication with the surgical, anaesthetic 💉, and nursing teams is vital.
🧾 Where possible, informed consent should be obtained either from the patient or from the next of kin 👪.
😷 If the patient is unconscious or unstable, surgery proceeds under implied consent, with thorough documentation 📝.
These steps ensure that the patient is stabilised 🛡️ as best as possible, risks have been considered and minimised ⚠️➡️✅, creating a safe and timely pathway for surgery 🏥 with a team that is well informed and working cohesively 🤝.
Build Knowledge✅
Improve Safety ✅
References:
ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, and the International ATLS working group. Advanced trauma life support (ATLS®): The ninth edition. Journal of Trauma and Acute Care Surgery 74(5):p 1363-1366, May 2013.
Freedman, R., O’Donnell, A., Ross, N., & Herbert, L. (2022). The major trauma patient. In Oxford Handbook of Anaesthesia. Oxford University Press, Incorporated. https://doi.org/10.1093/med/9780198853053.003.0037
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