What is the initial management of victims of a Motor Vehicle Collision (MVC)?

From the Guidelines

The initial management of motor vehicle collision victims should prioritize assessment and stabilization using the ABCDE approach, with consideration of transport to a trauma center based on specific criteria. The ABCDE approach includes:

• Airway: Ensure the airway is open and clear, performing jaw thrust or chin lift maneuvers as necessary, and considering intubation in severe cases.
• Breathing: Assess breathing and provide supplemental oxygen if needed, looking for signs of tension pneumothorax or flail chest.
• Circulation: Control any visible bleeding with direct pressure, assess for signs of shock, and start IV fluids if necessary, using crystalloids like normal saline or Ringer's lactate, starting with a 1-2 L bolus in adults.
• Disability: Perform a quick neurological assessment using the Glasgow Coma Scale and immobilize the cervical spine if there's any suspicion of injury.
• Exposure: Fully expose the patient to assess for hidden injuries, but maintain body temperature. Additional steps include performing a rapid trauma survey to identify life-threatening injuries, obtaining vital signs and continuously monitoring them, administering pain relief as needed, and considering tranexamic acid for patients with significant bleeding 1. According to the guidelines for field triage of injured patients, transport to a trauma center is recommended if any of the following are identified: falls from a certain height, high-risk auto crash, intrusion, ejection, death in the same passenger compartment, or vehicle telemetry data consistent with a high risk for injury 1. In terms of positioning the victim, as a general rule, a victim should not be moved, especially if there is suspicion of a spinal injury, but there are times when the victim should be moved, such as if the area is unsafe or if the victim is unresponsive and face down 1.

From the Research

Initial Management of MVC Victims

The initial management of victims of a Motor Vehicle Collision (MVC) involves several key steps, including:

• Establishment or maintenance of a patent airway, ensurance of adequate breathing, and resuscitation of the circulation, as stated in 2
• A cursory survey to identify immediately life-threatening injuries and to prevent permanent disability, as mentioned in 2
• Rapid recognition and prompt treatment of acutely life-threatening injuries in the order of their priority, as discussed in 3

Assessment and Treatment

The assessment and treatment of MVC victims may involve:

• Physical examination and ultrasonography according to the FAST concept (Focused Assessment with Sonography in Trauma) for the recognition of intraperitoneal hemorrhage, as described in 3
• Emergency thoracotomy for patients with penetrating chest injuries, massive hematothorax, and/or severe injuries of the heart and lungs, as stated in 3
• Emergency laparotomy for patients with signs of hollow viscus perforation, as mentioned in 3
• Computerized tomography with contrast medium for hemodynamically stable patients, as discussed in 3

Extrication and Care

The extrication and care of MVC victims may involve:

• Self-extrication as a preferred, primary approach, reducing extrication time, and moving away from absolute movement minimisation, as recommended in 4
• Use of the U-STEP OUT algorithm as a decision-making tool, as endorsed in 4
• Interdisciplinary collaboration, use of operational and clinical decision aids, and enhanced training, as emphasized in 4