An introduction to the initial hospital management of acute trauma

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4How to initially manage acute trauma
Dr Ammar Naser is Specialist Registrar in Anaesthesia, North Central Thames Rotation

Dr Robert CM Stephens is Consultant in Anaesthesia, University College Hospitals NHS trust London.

Dr Rita Das, is Consultant in Emergency Medicine, The Whittington Hospital NHS trust, London


A trauma team should consist of two to four doctors, three to five nurses and a radiologist / radiographer and porters. Before the patient arrives the team leader should assign each member a specific role before the patient arrives, (including someone to document findings and organise investigations), gowns and gloves should be put on and equipment checked.

The patient is most vulnerable during the first hour (‘golden hour’) of resuscitation. It is important to use a systematic method of examination and treatment to ensure that life threatening injuries are promptly identified. The standard approach is based on Advance Trauma Life Support (ATLS) methodology which consists of:

  • Primary survey and resuscitation:

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