Trauma medicine

In medicine, the area of trauma medicine practice principally is concerned with severe multisystem physical injury that can progress into irreversible shock. It encompasses both trauma surgery and trauma critical care. Victims of physical trauma may indeed suffer trauma (psychological), both acute and delayed-onset, but that is not the focus of this article.

The background of physicians who treat trauma varies by countries. In the United States, while it is not a specialty board, many of the leading practitioners are general surgeons who have had fellowship training in trauma. In other countries, it may be considered a collateral duty of general or orthopedic surgeons. Emergency physicians, obviously, are often the initial managers of the trauma patient.

Current concepts

"The modern operation is safe for the patient. The modern surgeon must make the patient safe for the modern operation" - Lord Moynihan

A key aspect of trauma practice is that multiply injured patients die of a "lethal triad" of three interacting factors:

• coagulopathy, or, as is still being defined, trauma induced coagulopathy
• hypothermia
• metabolic acidosis

The consequence of these trauma-related metabolic derangements is that the patient can only be submitted to enough damage control surgery, at one time, for "control of hemorrhage, prevention of contamination and protection from further injury," without making the metabolic disorders worse. Trauma surgeons now routinely split what had been one lengthy procedure in many, then turning to surgical critical care to prepare for the next procedure. Damage control surgery first was widely used when 9mm gunshot wounds became common in civilian practice, inflicting damage that had previously been associated with battlefield weapons. The surgical approach then moved to Iraq and Afghanistan, and a new generation then came back for civilian use.

Policy, legal and ethical challenges

While their principal responsibility is treatment, trauma specialists are very aware of the potentially preventable causes of trauma and may become involved in education. They also may be key advisers to field medicine on the prehospital care of the trauma patient.

Trauma physicians often see victims of accidents or violence, who are otherwise in good physical condition but have injuries incompatible with life. As such, they are potential organ or tissue donors, and obtaining consent is often stressful for all involved.