To Operate or Image? (Pulling the Trigger)
One of the common attributes of great trauma surgeons is that they seem (to us mere mortals) to have the ability to magically sort out who needs emergent intervention without all of that “new-fangled technology” that has replaced the physical examination and clinical judgment. I had the great opportunity to train under one such legendary figure, and quickly realized that the strongest predictor that the patient needed to go emergently to the operating room was when he pulled his cloth scrub cap out of his back pocket and put it on. We all learned to watch closely for this tell-tale sign, and how incredibly accurate it was for predicting life threatening injuries just by simple observation and examination. However, with close observation I came to realize that he was able to do this in large part by applying a basic set of rules and principles governed by common sense and a deep understanding of trauma mechanisms and anatomy. Although no chapter or guidelines can hope to replicate that level of judgment built on decades of experience and hard-earned lessons, you can easily adopt the principles and algorithms outlined here to manage the most challenging group of patients you will ever encounter: combat trauma patients.