4.3 Basic Rules of Trauma Evaluation 

• Airway patency and respiratory depression – Must be continually evaluated, preoperatively and postoperatively. Swelling from injury in the lung and airway can be slow and continue for a long time. 
• Cervical spine injury: Must be ruled out in every case of multiple trauma, especially falls and vehicle accidents. 
• Hypovolemia: Hypotension may not be present because of compensatory mechanisms, but always keep hypovolemia in mind as a possibility in any trauma victim. 
• Decreasing level of consciousness: Any patient who develops a decreasing level of consciousness during the assessment and watching period is assumed to have an internal head injury until proven otherwise. 
• Hypothermia: The trauma patient begins to lose body temperature from the moment of injury. Take all measures possible to maintain body temperature near normal and outcomes in trauma will be improved. 
• Full stomach: All trauma patients are considered to have a full stomach. Assume the patient ate a full dinner just minutes before the trauma. 

It is important for the anesthetist to remember that these patients may have an increased likelihood of being drug abusers, acutely intoxicated, and carriers of hepatitis or human immunodeficiency virus (HIV).