• W M Griggs, R W Morris, W B Runciman, G A Osborne, and A D Paix.
• Trauma Service, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
• Qual Saf Health Care. 2005 Jun 1; 14 (3): e21.

BackgroundAnaesthetists are regularly involved in the management of patients who have suffered trauma. Acute physiological derangements can occur at any time after the original injury, with life threatening sequelae. These problems may be complex in nature and evolve rapidly, often with an obscure aetiology, so a systematic approach to them is essential.ObjectivesTo examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for trauma, in the management of anaesthesia involving trauma cases.MethodsThe potential performance of a structured approach for each of the trauma incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved.ResultsThere were 38 relevant reports relating to trauma in the first 4000 reports to AIMS. In 39% of these there was "emergency corner cutting", although in the majority the urgency was thought to have been more perceived than real. The previously described "core" crisis management algorithm for crises during general anaesthesia was an effective means of discovering (82%), diagnosing (68%), and correcting (66%) the majority of trauma incidents. However a sub-algorithm specific for the traumatised patient was required for unusual, obscure, or complex presentations.ConclusionAlthough the small numbers preclude validation of the sub-algorithm, it would have successfully managed all the trauma cases reported to AIMS.

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