ABSTRACT
The development of the concepts of early total care and damage control surgery, together with significant advances in intensive care and the understanding of a systemic response to polytrauma, has played a key role in this process. The evaluation and management of polytrauma have been divided into the pre-hospital and in-hospital phases. Polytrauma patients are often young and healthy, with considerable physiological reserve, so they may not respond to even fairly severe blood loss in the expected way. The secondary survey does not commence until the primary survey is completed; when the primary survey is interrupted for transfer to the operating theatre or intensive care, or when the patient is unconscious, the secondary survey may be undertaken until several days after admission. In hospitals that have adopted the Advanced Trauma Life Support protocol, three conventional X-rays are routinely performed for polytrauma situations. The lateral C-spine X-ray is considered necessary to identify severe or unstable fractures, especially prior to intubation in an obtunded patient.
