Approach to Trauma Patients in the ICU

All patients with life threatening traumatic injuries come to the ICU

Patients with multiple traumatic injuries necessitate multiple specialty services and coordinated care.  Common services involved include:

• Trauma
• Ortrhopaedic Surgery
• Neurosurgery
• Spine Surgery
• Vascular Surgery
• Opthalmology (for orbital fractures and disruption of the globe)

The initial primary survey and resuscitation of trauma patients takes place in the Trauma Bay or in the Operating Room and focuses on 

• Airway: traumatic airway injuries, facial bone and jaw fractures
• Breathing: pneumothorax, hemothorax, lung contusions, drownings
• Circulation: hemorrhage and hemodynamics
• Disability: Traumatic brain and spinal cord injuries
• Exposure:  patients are disrobed to ensure no life or limb injuries are missed and a heating blanket is applied

If they are unstable with thoracic and/or intraabdominal injuries they will be taken direction to the OR for exploratory surgery. 

If they are reasonably stable they will have a CT scan of head, cervical spine, chest, abdomen, and pelvis and a secondary survey will be performed prior to ICU transfer

They will receive their tetanus immune globulin in emergency

They will all arrive to the ICU having had baseline blood work and when indicated, toxicology screens

Most will arrive intubated, in cervical collars, on log roll precautions, and with pleural drains in situ

They may or may not have central lines (mostly not as this is not a priority during resuscitation where good IV access exists)