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Overview of inpatient management in the adult trauma patient

Babak Sarani, MD, FACS
Niels Martin, MD, FACS
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Trauma remains the leading cause of death in those less than 44 years of age in the United States, and for those older than 45, trauma is one of the top five causes of death. The management of patients with traumatic injuries presents a variety of challenges. Patients have usually undergone multidisciplinary evaluation, resuscitation and stabilization in the emergency department and possible operative intervention prior to inpatient admission. Patients remain at risk for complications due to unrecognized injuries, or related to initial or ongoing management.

The general care and management of injured patients who require hospital admission are reviewed here. Initial evaluation and treatment in the emergency department are discussed separately. Specific injuries are discussed in separate topic reviews. (See "Prehospital care of the adult trauma patient" and "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of penetrating thoracic trauma in adults".)


Ongoing inpatient assessment and monitoring are critical to managing injured patients. This is particularly true in patients who have undergone damage control surgery or those with injuries that are being managed nonoperatively such as blunt splenic, hepatic, duodenal or pancreatic injury. Recognition of the full extent of traumatic injury requires an accurate history, skillful physical examination, and timely and judicious use of diagnostic studies.

Obtain a complete history — Patients with serious traumatic injuries often are unable to give details of their past medical history upon presentation to the emergency department and collateral sources of information (eg, family or friends) may not be available initially. It is therefore incumbent upon the admitting clinician to obtain additional information about past medical history, outpatient medications, allergies, and any history of drug or alcohol use.

It is also important to obtain information about the circumstances that led to the injury since falls from a height or motor vehicle collisions may have been precipitated by medical causes such as cardiac dysrhythmia, hypoglycemia, or stroke, and injuries from assault may be a result of domestic violence. In addition, self-inflicted injuries may be a manifestation of a psychological disorder that needs to be identified and treated.


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Literature review current through: Sep 2016. | This topic last updated: Oct 4, 2016.
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