Intended for healthcare professionals

Student Education

Trauma surgery: Back to basics

BMJ 2003; 326 doi: (Published 01 April 2003) Cite this as: BMJ 2003;326:0304100
  1. Omar Mukhtar, final year medical student1,
  2. Kirsten Jones, consultant in emergency medicine2
  1. 1University of Bristol
  2. 2Frenchay Hospital, Bristol

Trauma fascinates many medical students, but to handle acute emergencies it is necessary to follow the principles of the primary and secondary survey. In the first part of a new series, Omar Mukhtar and Kirsten Jones go back to basics

Gunshot wounds, stabbings, and burns are disturbing but common events that many doctors deal with the world over. Although Hollywood might depict these injuries as glamorous, reality is different and often distressing. In this series we will cover non-ballistic and ballistic trauma, as well as burns. A sound understanding of resuscitation is necessary in all of these situations, which we take you through in this first article.

The first rule of medicine: do no harm

The principle of doing no harm should not be taken lightly. Although aggressive interventions may be needed during the resuscitation and evaluation of an acutely injured patient, a patient is most vulnerable during this time. Thus, it is important to use a systematic method of examination and treatment to ensure that life threatening injuries are quickly identified; other significant injuries also need to be treated before they cause additional problems. The standard approach consists of primary survey, resuscitation, detailed secondary survey, and initiation of definitive care.

Appropriately qualified personnel and the necessary equipment should be available and ready before any patient is admitted to aid this management system.

Preparation and the trauma team

A trauma team usually consists of four doctors, five nurses, and a radiographer. In many parts of the world, including parts of the United Kingdom, however, this is not possible, and the trauma team consists of two or three doctors and a similar number of nurses. …

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