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Management of The Multiply-Injured Patient

The document discusses the management of patients with multiple traumatic injuries, or polytrauma. It defines polytrauma as injuries to more than one body region with at least one life-threatening injury. It then covers the epidemiology, including that motor vehicle accidents account for the majority of cases. It also discusses trauma scoring systems used to assess patient status and prognosis. The document outlines the initial evaluation and management of polytrauma patients, including assessing respiratory, hemorrhagic, and neurological status along with staging patients based on physiological stability. It also reviews early radiological investigations and surgical strategies for treating injuries.

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242 views34 pages

Management of The Multiply-Injured Patient

The document discusses the management of patients with multiple traumatic injuries, or polytrauma. It defines polytrauma as injuries to more than one body region with at least one life-threatening injury. It then covers the epidemiology, including that motor vehicle accidents account for the majority of cases. It also discusses trauma scoring systems used to assess patient status and prognosis. The document outlines the initial evaluation and management of polytrauma patients, including assessing respiratory, hemorrhagic, and neurological status along with staging patients based on physiological stability. It also reviews early radiological investigations and surgical strategies for treating injuries.

Uploaded by

jgej.md
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Management of the

Multiply-Injured Patient
Jomelle Gem E. Justiniani

Outline

Definition
Incidence, Epidemiology, Mortality
Trauma Scoring Systems
Pathophysiology and Immune Response
Initial Evaluation and Management
Radiologic Investigations
Standard Care for Treatment of Skeletal Injuries
Rehab
Take Home Points

Polytrauma
Subgroup of injured patients who
have sustained injuries to more than
one body region and organ with at
least one of the injuries being lifethreatening

Epidemiology
Occurs in 15-20% in overall trauma
population
MVA accounts for 37.9% of all cases
Falls account for 30.2%
Blunt trauma accounts for 86.2%
Penetrating trauma 11.1%
Burns 1.7%

Epidemiology
Risk Factors:
Alcohol use (BAC > 0.08%)
Failure to wear a seat belt
Failure to have an air bag
Failure to wear a helmet

Trauma Scores
Anatomic
AIS
ISS

Physiologic
TS
RTS

Combination
TRISS
ASCOT

Trauma Scores
AIS

Trauma Scores
AIS

Trauma Scores
ISS
To calculate an ISS for an injured person, the body is
divided into six ISS body regions. These body regions
are:
1. Head or neck - including cervical spine
2. Face - including the facial skeleton, nose, mouth, eyes
and ears
3. Chest - thoracic spine and diaphragm
4. Abdomen or pelvic contents - abdominal organs and
lumbar spine
5. Extremities or pelvic girdle - pelvic skeleton
6. External

Trauma Scores
RTS

Pathophysiology and Immune


Response
Ebb (shock)
Flow up to 2 weeks
Recuperation lasts up to several
months

Pathophysiology and Immune


Response
Neuroendocrine system:
Adrenocortical response:
Release of adrenocorticosteroids and
catecholamines
Increased heart rate, respiratory rate, fever, and
leukocytosis

Pathophysiology and Immune


Response

Pathophysiology and Immune


Response

Initial Management
Reanimation Period (1 to 3 hours)
Time of admission to control of lifethreatening conditions

Primary Stabilization Period (1 to 48


hours)
Complete stability of respiratory,
hemodynamic, and neurologic systems
Major extremity injuries are managed

Initial Management
Secondary Regeneration Period (2-10
days)
Patient stabilized and monitored

Tertiary reconstruction and


rehabilitation period (weeks)
Final reconstructive measures

Initial Management
Respiratory Function Assessment
Management of Hemorrhagic Shock
Assessment of capillary refill time,
conjunctiva color, urine output
Frequent sources of hemorrhage:
Abdomen
Thorax
Pelvis

Initial Management
Neurologic Status Assessment

Initial Management
Neurologic Status Assessment

Initial Management
Staging:
Stable have physiologic reserve to
withstand prolonged operation
intervention
Borderline stabilized in response to
initial resuscitative attempts but have
clinical features, or combinations of
injury

Initial Management
Staging:
Borderline:

Initial Management
Staging:
Unstable remain hemodynamically unstable
despite initial intervention; at greatly increased
risk of rapid deterioration, subsequent multiorgan failure, and death
In Extremis very close to death; having
suffered severe injuries, often with ongoing
uncontrolled blood loss
Deadly triad:
HYPOTHERMIA
ACIDOSIS
COAGULOPATHY

Early Radiologic
Investigations
Radiography:
Chest AP
Cervical spine
pelvis

Early Radiologic
Investigations
Ultrasound:

Early Radiologic
Investigations
Ultrasound:

Arteriography
For traumatic aortic and vascular
injuries

Early Radiologic
Investigations
Ultrasound:

Arteriography
For traumatic aortic and vascular
injuries

Surgical Strategy and Decision


Making
Damage Control Orthopaedics
Seeks to control but not to definitively
repair the trauma-induced injuries early
after trauma
Attempts to reduce the biological load of
surgical trauma in the alreadytraumatized patient

Surgical Strategy and Decision


Making
Damage Control Orthopaedics
FIRST STAGE: early temporary
stabilization of unstable fractures and
the control of hemorrhage
SECOND STAGE: resuscitation of
patients in ICU with optimization of their
condition
THIRD STAGE: delayed definitive fracture
management

Priorities in Fracture Care


Consideration of progressive soft
tissue damage : tibia, femur, pelvis,
spine, and upper extremity
Immobilization of shaft fractures
Priority of treatment dictated by
extent of bone and soft tissue
damage femoral head fractures and
talar fractures

Closed Fracture

Open Fracture

Reconstructive versus
Amputation

Rehabilitation
has to start during the immediate
postoperative period mobilization
under the supervision of a trained
physiotherapist

Take Home Points

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