Early management of the critically injured.

A plan for the early management of the critically injured patient is described with emphasis on the priorities of management of injuries to certain organ-systems. The most important priorities are the establishment and maintenance of adequate ventilation and adequate circulation. The general surgeon is best qualified to assume full responsibility for the proper care of the critically injured, of patients with multiple injuries, and of patients in traumatic shock. He must assume the risk of transfusing unmatched whole blood and of deferring non-essential radiographs. The emergency and radiology departments may have to be by-passed to save the life of the critically injured patient. The measures required to establish a clear airway, to treat complications which can impair ventilation, to manage shock and hemorrhage and the possible complications of massive transfusions of blood are reviewed.