Preparing the Trauma Patient for Surgery

assessment safety trauma Apr 14, 2025

๐Ÿฅ 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. โฑ๏ธ Most networks will have some form of trauma response call ๐Ÿšจ prior to the patient arriving in theatre, allowing some time for staff to prepare! ๐Ÿง‘‍โš•๏ธ๐Ÿ‘ฉ‍โš•๏ธ

When preparing for a trauma patient, here are your top 5 considerations! โœ‹

๐Ÿฉบ Primary Survey and Resuscitation
๐Ÿ“‹ This follows the Advanced Trauma Life Support (ATLS) principles:
Airway

โค๏ธ Breathing
๐Ÿฉธ Circulation
๐Ÿง  Disability

๐Ÿง‍โ™‚๏ธ Exposure (ABCDE)
โš ๏ธ Immediate life-threatening issues must be addressed prior to transfer to the operating suite, with haemodynamic stability a priority, often requiring ๐Ÿ’‰ fluid resuscitation and ๐Ÿฉธ transfusion.

๐Ÿ–ผ๏ธ Imaging and Diagnostics
๐Ÿงพ Targeted imaging helps identify injuries needing surgical intervention. Standard trauma imaging includes:
๐Ÿ“ธ Chest and pelvic X-rays
๐Ÿ–ฒ๏ธ FAST (Focused Assessment with Sonography for Trauma)
๐Ÿง  CT scans
โณ 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.

๐Ÿง  Airway Protection and Cervical Spine Clearance
๐Ÿ—ฃ๏ธ Airway management is essential, particularly in patients with ๐Ÿค• altered consciousness or facial trauma.
๐Ÿฆด Cervical spine injuries must be assumed in all trauma patients until proven otherwise.
๐Ÿ“‹ Clearance involves clinical assessment in alert patients without neck pain or neurological symptoms and sometimes imaging like a CT scan ๐Ÿง .
๐Ÿ›๏ธ The C-spine must remain immobilised until confirmed clear to prevent spinal cord injury ๐Ÿงฌ.

๐Ÿ“ Definitive Diagnosis and Surgical Planning
๐Ÿ” Once life-threatening conditions are addressed and imaging is complete, the surgical team can determine the need for and timing of surgery โฐ.
๐Ÿงช This includes evaluating coagulopathy ๐Ÿงฌ, organ dysfunction ๐Ÿซ€๐Ÿซ, and the patient’s physiological status ๐Ÿฉบ.

๐Ÿ—ฃ๏ธ Communication and Consent

๐Ÿง‘‍โš•๏ธ Effective communication with the surgical, anaesthetic ๐Ÿ’‰, and nursing teams is vital.
๐Ÿงพ Where possible, informed consent should be obtained either from the patient or from the next of kin ๐Ÿ‘ช.
๐Ÿ˜ท If the patient is unconscious or unstable, surgery proceeds under implied consent, with thorough documentation ๐Ÿ“.

These steps ensure that the patient is stabilised ๐Ÿ›ก๏ธ as best as possible, risks have been considered and minimised โš ๏ธโžก๏ธโœ…, creating a safe and timely pathway for surgery ๐Ÿฅ with a team that is well informed and working cohesively ๐Ÿค.

Build Knowledgeโœ…
Improve Safety โœ… 

 

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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