Current priorities in the management of multiple injury

In the busy moments of early resuscitation, it is not always obvious which injuries should take precedence. Correct prioritization has received little attention, but there are a number of studies examining new diagnostic modalities that can help in the early decision-making process. Multiply injured patients with head injury are common, and this paper reviews the prioritization of their management and appropriate timing of associated fracture fixation. Also, delays in obtaining aortography in patients with suspected torn thoracic aorta can be a problem and, thus, the use of CT and transesophageal echocardiography in these patients is reviewed. Recent ultrasound series are reviewed because abdominal ultrasound shows promise as a screening modality after multiple trauma. A negative ultrasound allows for prioritization of other injuries; a positive ultrasound prioritizes treatment of intra-abdominal injury. Finally, recent additions to the literature on emergent stabilization of severe pelvic fractures and the appropriate timing of fixation of long-bone fractures in patients with lung injury are discussed.