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September 14, 1970

Initial Management of the Severely Injured Patient

Author Affiliations

From the Department of Surgery, the University of Texas Southwestern Medical School, Dallas.

JAMA. 1970;213(11):1872-1878. doi:10.1001/jama.1970.03170370056010

Immediate categorization and an organized plan of management serve to expedite and improve medical care of the severely injured patient. While consultation is obtained from all necessary specialty services, the responsibility should rest with one physician who is able to evaluate the patient's overall problem. With this approach in mind, the following is a description of an approach which has proved practical and effective.

Priority by Injury  Patients may be placed in one of three categories, according to the severity of the injury.1 The first category includes injuries which interfere with vital physiologic function and constitute an immediate threat to life, such as a gunshot wound, or an obstructed airway. The primary treatment is to establish an airway and control the bleeding. This type of patient may require surgery within five to ten minutes following arrival, especially if there is massive internal bleeding. The operating room is alerted to