The initial management of orthopedic trauma is not substantially different from that of any other injured patient. Airway and ventilatory management remain the highest priorities. Early definitive management in patients with multiple extremity fractures, serious pelvic injury, and high spine injuries with deficit should be considered. The evaluation process will often include multiple evaluations and treatments in remote locations, such as the radiology suite, CT, and angiography, where there may not be suitable provisions for emergent airway management. Early intubation, often before the clearance of the cervical spine, is frequently needed to allow for reduction of fractures or dislocation. Continuous vigilance of the adequacy of ventilation and oxygenation must be maintained throughout the evaluation process. Maintaining adequate circulation becomes the next highest priority. Intravenous access should be established with large-bore peripheral catheters if possible, but extremities with known injuries should be avoided. Use of central venous lines may be necessary, although femoral or lower extremity cutdowns should be avoided in suspected pelvic or lower extremity injuries, respectively, because of the potential for venous injury and exacerbation of pre-existing blood loss. In addition, it is important to anticipate the need for blood products171 and to be prepared for massive blood transfusion if indicated.