Care of the patient with multiple injuries requires a team approach, with one person responsible for coordinating the treatment. Im-mediately after injury, the body is hypermetabolic, hypercoagu-lable, and severely stressed. Mortality in patients with multiple injuries is related to the severity of the injuries and the number of systems and organs involved.
Multiple trauma potentially affects every body system. The nursing staff assumes responsibility for assessing and monitoring the patient, ensuring intravenous access, administering prescribed medications, collecting laboratory specimens, and documenting activities and the patient’s response.
Gross evidence of trauma may be slight or absent. The injury re-garded as the least significant in appearance may be the most lethal. For example, the pelvis fracture not identified until x-ray may be the injury from which the patient is exsanguinating into the pelvic cavity. Another example is a pneumothorax that is in-sidiously increasing in size, affecting both the heart and lungs, while the staff are focused on the treatment of external lacera-tions. An obvious amputation of the arm may have already stopped bleeding from the body’s normal response of vasocon-striction, despite being obvious and a devastating injury; mean-while, the patient may be dying from an internal, not so visible, injury.
The goals of treatment are to determine the extent of injuries and to establish priorities of treatment. Any injury interfering with a vital physiologic function (eg, airway, breathing, circulation) is an immediate threat to life and has the highest priority for immediate treatment. Essential life-saving procedures are per-formed simultaneously by the emergency team. As soon as the patient is resuscitated, clothes are usually cut off, and a rapid phys-ical assessment is performed. Transfer from field management to the ED must be orderly and controlled, with attention given to the verbal report from emergency medical services. Treatment in a level I trauma center is appropriate for patients experiencing major trauma. Treatment priorities are illustrated in Figure 71-3.