Initial treatment of patients with extensive trauma

To the Editor: Dr. Trunkey provides a useful overview of the care of the patient with life-threatening injuries (May 2 issue).¹ We certainly agree that timely and appropriate operative intervention is key to the successful treatment of the seriously injured patient. However, the decision to perform emergency laparotomy, particularly in the context of multisystem trauma, can be vexing. We wish to underscore the pivotal role of diagnostic peritoneal lavage in such cases. Dr. Trunkey acknowledges the usefulness of diagnostic peritoneal lavage, notably in the evaluation of the patient “whose condition is unstable.” Moreover, he promulgates the tenets of the Advanced.