Polytrauma

Polytrauma is the involvement of at least two organ systems, at least one of which threatens the patient's life .

A combined injury is an impairment of at least two organ systems that do not threaten the patient's life.

Epidemiology

Polytraumas are the most common cause of death under the age of 40, the incidence of trauma-related deaths in developed countries is 60-80/100,000 population, it is the fifth most common cause of death, the most common cause is traffic accidents.

Distribution of deaths

Immediate - 50% during the first 30 min. – serious injuries to the brain , spine, heart or large vessels.
Early - 30% in the first 4 hours - DC obstruction, insufficient ventilation, hemo - pneumothorax .
Late - 20% ARDS, MOF, sepsis, pulmonary embolism .

Mechanism of injury

High speed vehicle collisions.
Fall from more than 4 meters.
Explosion.
Backfilling.

Typical injury mechanisms cause typical injuries:

frontal impact – direct injury to the head, cervical spine, lower limbs, pelvis and chest;
fall from a height – lower limb fractures, skull base fractures, trauma to the spine, pelvis, injuries to internal organs;
blast – chest, limb, abdominal trauma, blast syndrome – pressure wave injury;
crushing – crush syndrome, damage to internal organs.

Polytrauma surgical scoring

Abbreviated Injury Scale = AIS

Individual injuries are evaluated according to the degree of severity from 1 to 6 - from the lightest 1 to the most severe (inoperable) 6.

Injury Severity Score = ISS

Individual injuries are graded according to the AIS scale - and divided into six areas (head, face, chest, abdomen, limbs including pelvis, external injuries) - only the highest AIS value in the given region is counted. The ISS takes on values from 0 to 75. If a region in the AIS is rated as grade 6 (inoperable), the ISS automatically takes on the value of 75.

Example

Region

Description of injury

AIS

Values of the three most difficult ²

Head and neck

Brain contusion

3

9

Face

No injuries

0

Thorax

Flail chest

4

16

Belly

Mild liver contusion

Rupture of the spleen

2

5

25

Extremities

Femur fracture

3

External injuries

No injuries

0

ISS

50

^[1]

Management of care for the polytraumatized patient

Caring for a polytraumatized patient usually begins with the treatment and transport of a polytraumatized patient by an RLP doctor (Rapid Medical Aid – a type of medical emergency service crew whose member is a doctor). It is important to set priorities and maintain calm and balance.

EMS doctors (medical emergency service)

Upon arrival at the scene - determination of the number of injuries, evaluation of the severity of injuries, stopping life-threatening bleeding, ensuring airways, securing venous access, pharmacotherapy, volume therapy, transport to a trauma center or an appropriate medical facility.

Algorithm

- A – Airway – ensuring patency of airways (!Watch out for spinal trauma).
- B – Breathing – assessment of breathing, frequency, sight, palpation, listening (chest injury, tracheal deviation, pneumothorax) and the resulting measures – mask breathing, chest puncture, etc.
- C - Circulation - Palpation of the pulse - if it is not palpable, we start immediate resuscitation, if the pulse is palpable, we measure the pulse, pressure - procedures - stop the bleeding, ensure venous access, replenish the volume, take blood for KO, HTK.
- D – Disability – indicative neurological examination – head trauma, pupil size, state of consciousness GCS .
- E – Examination – Orientation examination of other body systems – chest, abdomen, limbs.
- T – thermal management, transport and documentation. ^[2]

Hospital phase

Structure of the ATLS (Advanced Trauma Live Support) trauma protocol

Short overall evaluation

rough orientation, medical history.

Primary evaluation

A, B, C, D, E – possible resuscitation, then:

Disarmament, venous access 2 cannulas at least 14G, BP, TF, saturation.

Secondary evaluation follows stabilization of vital functions.

Clinical examination, X-ray, chest drainage, CVK, urinary catheter, ultrasound of the abdomen, CT of the spine and skull, arterial access , CT of the head.

Definitive treatment.

Treatment of serious injuries

Urgent income + life-saving services.
The first diagnostic phase within 30 minutes.
Injury stabilization and stabilizing surgery 2-3 hours (necessary to stabilize the patient).
Second diagnostic phase + definitive stabilization 7.–10. day.
Delayed performance and recovery

Composition of the trauma team

Traumatologist
Anesthesiologist, intensivist
Surgeon
Radiographer
Neurosurgeon, neurologist, orthopedist, ENT, urologist, oral and maxillofacial surgeon...