Polytrauma patients Objectives 1 Defenition 2 Prevalence 3

Polytrauma patients

Objectives 1 -Defenition 2 -Prevalence 3 -Etiology 4 -pathophysiology 5 -type of shock in polytrauma 6 -Mangment

Definition “polytrauma” = (Multisystem trauma) which means injury of two or more systems. Poly-trauma means a syndrome of multiple injuries with systemic traumatic reactions which may lead to dysfunction or failure of remote organs and vital systems.

Prevalence § World wide No. 1 cause of death amongst the younger age group (1844 yrs). § Third most common cause of death in all age groups.

Etiology of polytrauma • • RTA Fall from height Blunt (Heavy object inj. ) or penetrating injury Assault Airplane crashes , train derailment Blast Thermal , chemical injury

Etiology of polytrauma

Death in polytrauma • Immediate trauma death/First peak of death. • Early trauma death /Second peak of death. • Late death /Third peak of death.

First peak of death/Immediate trauma death • Severe head injury • Brain stem injury • High cord injury • Heart and major vessel injury • Massive blood loss

Second peak of death / Early trauma death • Intracranial bleed • Chest injury • Abdominal bleeding • Pelvic bleeding • Multiple limb injury

Third peak of death / Late death It occurs after several days or weeks due to – Sepsis – Organ failure

AIMS IN MANAGEMENT “TO RESTORE THE PATIENT BACK TO HIS PRE-INJURY STATUS” HAVING FOLLOWING PRIORTIES: • LIFE SALVAGE • LIMB SALVAGE • SALVAGE OF TOTAL FUNCTION IF POSSIBLE

LIFE SALVAGE • 50% deaths due to trauma occurs before the patient reaches hospital. • 30% occurs within 4 hrs of reaching the hospital. • 20% occurs within next 3 weeks in the hospital. • If preventive measures are taken, 70% deaths can be prevented meaning 30% deaths are nonsalvagable deaths.

Golden Hour • Rapid transport of severely injured patient to a trauma center with in one hour • Chances of survival diminishes after one hour • Platinum 10 minutes: Only 10 minutes of the Golden hour may be used for on-scene activities

PRE-HOSPITAL PHASE • BASIC EMERGENCY MEDICAL TECHNICIAN SKILLS 1. Maintenance of Airway ( endotracheal intubation) 2. Cardiopulmonary resuscitation 3. Fluid replacement with isotonic solution 4. Reduction and splintage of fractures 5. Perform primary survey of patient and report findings to destination center

TRIAGE

TRIAGE • Triage is usually used in a scene of an accident or "mass-casualty incident”. • To sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries.

TEAM OF CONSULTANTS FOR POLY TRAUMA • Team Leader – General Surgeon • Orthopedic surgeon • Neuro surgeon • Thoracic surgeon • Accident and emergency medical officer • Urologist • Anesthesiologist

1. Make the area safe 1 -protect yourself, the causalty and other road users. – Park your car safely, turn lights on, set hazard lights flashing. – Do not across a bussy motorway to reach other side – Set others to warn other comming drivers – Set up warning triangles or lights 200 metres in each direction. 2 -Switch off ignition of any damaged vehicle. 3 -Is anyone smoking?

2. Check all caulsalties • quick assess • no moving • apply life-saving treatment

3. Treat § in the position found § first life-threatening or potentially serious injuries § Stop bleeding § Splintages for fractures § Cleaning of wounds and sterile dressing if possible

4. search all area For other injured persons For other potential sources of injuries

How to move unconscious casualty

How to move unconscious casualty • do not move the casualty unless it is absolutely necessary • assume neck injury until proved otherwise • – support head and neck with your hands, so he can breathe freely • Apply a collar, if possible • – There should be only 1 axis (head, neck, thorax) no moving to sides, no flexion, no extension. • – with other 3 -4 people 1 support head (he is directing others), other one shoulders and chest, other one hips and abdomen, last one - legs.

Assessment of the injured patient 1 -Primary survey and resuscitation A = Airway and cervical spine B = Breathing C = Circulation and hemorrhage control D = Dysfunction of the central nervous system E = Exposure 2 -Secondary survey 3 -Definitive treatment

PRIMARY SURVEY Life threatening conditions are identified and management is instituted simultaneously • Airway obstruction • Tension pneumothorax • Hemothorax • Open thoracic injury and flail chest • Cardiac tamponade • Massive internal or external hemorrhage

Type of shock in polytraumatized patient 1. Hemorrhagic shock due to loss blood volume , diagnosis based on vital sign and examination characterized by hypotension tachycardia and cold skin 2. neurogenic shock due to spinal cord injury that causes distribution of sympathetic outflow to heart and blood vessels characterized by hypotension. bradycardia. warm skin 3. hypoxic shock 4. septic shock

Pathophysiology q. It is a complex phenomenon aiming at the restoration of homeostasis and preservation of life. q. Major trauma induces an intense immuno-infl amatory response. q. The magnitude of this response depends on the initial trauma load, the pain stimuli, the systemic and local release of proinflammatory cytokines, age, sex as well as the genetic make-up of the patient.

Pathophysiology § Traumatic injury leads to systemic inflammation (systemic inflammatory response syndrome) followed by a period of recovery mediated by a counterregulatory anti-inflammatory response. § Within this inflammatory process, there is a fine balance between the inflammation and the potential for the process to cause and aggravate tissue injury leading to ARDS and MODS

Pathophysiology

Pathophysiology

Damage Control Surgery Patients

TIMING OF SURGERY v. Day 1: Early total care- stable patients v. Day 2 -5: Avoid surgery SIRS 2 nd hit is common v. Day 5 -10: WINDOW OF OPPORTUNITY v. After Day 10 - high infection rate.

SUMMARY • Polytrauma must be considered as a systemic surgical disease • Primary objective is survival of patients • Early fixation of major fractures – performed with right concept has proved to be an important tool to obtain this primary objective.

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