ABSTRACT
Many general surgery residents would prefer that all patients who come to an emergency department (ED) require treatment for gunshot wounds to the anterior abdomen. Because the priorities are clear, the algorithm for such treatment is straightforward, the workup required is minimal, the surgical approach necessitates a laparotomy, and interaction with other services is minimal. Alas, the management of trauma is usually not this simple. At most trauma centers, blunt trauma predominates, injuries regularly require an extensive workup, the management algorithm is complex, and clear supportive evidence for treatment choices is not always found in the medical literature. Optimal care in these situations is achieved only when the general surgeon can interact smoothly with a variety of other specialists, particularly neurosurgeons and orthopedic surgeons. We frequently depend on the services of anesthesiologists, cardiac surgeons, and interventional radiologists. Coordinating the actions of our colleagues, prioritizing treatment for various injuries, and selecting appropriate diagnostic tests in the optimal sequence require an understanding of the complex interactions between different types of injuries and the perspectives of our subspecialty colleagues. Prominent areas of controversy include the evaluation and treatment of patients with combined head and abdominal injuries, combined blunt aortic injury and abdominal injury, and the timing of fracture fixation in patients with severe pulmonary or brain injury.
