Therapeutic Sequences in the Acute Period in Unstable Patients

Abstract

This chapter deals with emergency treatment of severely or multiply injured victims in the resuscitation room who upon admission obviously are dying or unstable or have decompensated vital functions. Most commonly these critical conditions are exsanguinating hemorrhage, acute pump failure, obstruction of airways, mechanical failure of ventilation, or severe brain damage with tentorial herniation. A rapid survey suggests whether the trauma victim is unstable or dying, which requires urgent clearing and securing of airways, ventilatory support, massive volume infusion, and control of rapid external bleeding. Here, treatment precedes diagnosis! The first priorities of the advanced trauma life support (ATLS) course address the traditional ABCs of resuscitation: A = airway and cervical spine control, B = breathing, and C = circulation, cerebrum, cord. If effective, resuscitation cannot be achieved by conventional measures such as intubation, ventilation, and volume replacement, immediate life-saving surgical procedures are required.