Deterioration

The approach to a deteriorating trauma patient should be no different from any other patient. Trauma patients however, can be complex and deterioration of any particular vital sign may be the result of a complex interaction of a number of causes.

A structured approach helps ensure important signs are not missed and early deterioration is recognised; it helps determine priorities as well as minimising the effects of distraction and prevents important issues from being overlooked.

Managing a trauma patient requires careful observation in the period from arrival at a non-MTS, through to emergent retrieval, with a focus on two key outcomes of traumatic injury:

• Primary injury: outcomes of the initial mechanical forces that occur from the traumatic event.
• Secondary injury: non-mechanically caused outcomes of traumatic injuries which may be superimposed on the primary injuries already identified⁹.

Effectively managing a deteriorating trauma patient may require simultaneous resuscitation and assessment. Any deterioration of a trauma patient indicates the need to revisit the primary and secondary surveys to guide further intervention.