In dealing with an extensively injured patient, the most immediate problems consist of preventing asphyxia, stopping hemorrhage, replacing blood, and avoiding damage during transportation. The physician who first examines the patient must be systematic, and after the immediately evident problems have been dealt with the less obvious injuries must be considered. Fractures of extremities are overlooked in some cases; in others they hinder the physical examination and may divert the examiner's attention from serious spinal, intra-abdominal, or intrathoracic injuries. Sucking wounds of the chest, severe uncontrolled hemorrhage, and penetrating wounds of the abdomen require emergency operation. When combined abdominal and thoracic injuries are encountered, the thoracic portion is undertaken first. In many situations prompt action is more important than specialized knowledge, and such measures as clearing the airways by aspiration or tracheotomy, closure of open chest wounds, transfusion, splinting, or amputation may be lifesaving.
Aufranc OE. CARE OF THE PATIENT WITH MULTIPLE INJURIES. JAMA. 1958;168(16):2091–2094. doi:10.1001/jama.1958.03000160005002
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