Resuscitation after high energy polytrauma.

The majority of patients with polytrauma seen in the UK are victims of blunt injury. The trauma reception team approach, using a predetermined plan for initial assessment and urgent resuscitation, can improve outcome. It is important, therefore, that each member of the team is familiar with both their own role and that of their colleagues. This chapter reviews the immediate management of the patient with polytrauma, focusing on the importance of the 'ABC' approach. Optimal management of the trauma airway is essential and the benefits of early intubation and alternative techniques for securing the difficult airway are discussed. The early identification and management of life-threatening respiratory and circulatory complications is emphasised. Accurate assessment of shock in the victim of trauma is difficult, as the simple clinical indicators are not ideal. Some of the techniques available for advanced assessment of tissue perfusion are discussed in detail. The management of polytrauma provides a considerable clinical challenge, and this chapter emphasises the importance of a team approach.