multiple injuries su 3
TRANSCRIPT
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Multiple Injuries
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Polytrauma -- Multisystem trauma
Terminology:
• Injury = the result of harmful event that arises from the release of specific forms of energy.
• Trauma = defined as the morbid condition of body produced by external violence.
• “polytrauma” = Multisystem trauma = injury of two or more systems, one or the combination imperil vital signs.
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Pathophysiology of Trauma
• A major trauma is characterized by a series of complex pathophysiological reactions, some directly as a result of the event itself, others as part of a compensatory response.
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• The main features are triggered by: hypoxia shock neurohumoral responses
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INJURY BIOMECHANICS AND ACCIDENT PREVENTION
The magnitude of an injury is related to energy transferred to the victim during the event,the volume/area of tissue involved and the time taken for the interaction.
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Trauma deaths have a trimodal distribution
• First peak –Within minutes of injury –Due to major neurological or vascular injury –Medical treatment can rarely improve
outcome
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• Second peak –Occurs during the 'golden hour' –Due to intracranial haematoma, major
thoracic or abdominal injury –Primary focus of intervention for the
Advanced Trauma Life Support (ATLS) methodology
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• Third peak –Occurs after days or weeks –Due to sepsis and multiple organ failure
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Types of Blast Injuries
• Primary –Due to direct effect of pressure
• Secondary–Due to effect of projectiles from explosion
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• Tertiary–Due to structural collapse and from persons
being thrown from the blast wind• Quaternary –Burns, inhalation injury, exacerbations of
chronic disease
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Other Primary Blast Injuries
• Eye – Globe rupture, serous retinitis, hyphema, lid
laceration, traumatic cataracts, injury to optic nerve
– Signs and symptoms include eye pain, foreign body sensation, blurred vision, decreased vision, drainage
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• Brain – TBI due to barotrauma of gas embolism – Signs and symptoms include headache,
fatigue, poor concentration, lethargy, anxiety, and insomnia
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Tertiary Blast Injuries
• Due to persons being thrown into fixed objects by wind of explosions
• Also due to structural collapse and fragmentation of building and vehicles
• Structural collapse may cause extensive blunt trauma.
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–Crush syndrome • Damage to muscles and subsequent release of
myoglobin, urates, potassium, and phosphates• Oliguric renal failure
–Compartment syndrome • Edematous muscle in an inelastic sheath
promotes local ischemia, further swelling, increased compartment pressures, decreased tissue perfusion, and further ischemia
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Quaternary Blast Injuries
• Explosion related injuries or illnesses not due to primary, secondary, or tertiary injuries – Exacerbations of preexisting conditions, such as
asthma, COPD, CAD, HTN, DM, etc.
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Burns (chemical and thermal) •White Phosphorous (WP) from munitions
causes extensive burns, hypocalcemia and hyperphosphatemia
–Toxic inhalation–Radiation exposure–Asphyxiation (carbon monoxide and
cyanide)
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Triage
• Pre-hospital triage• At the scene of trauma• On arrival at the receiving hospital
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Managing a major trauma situation
1. Plan for eventuality2. Set up the trauma team before the patient arrive.3. Organize lines of communication and command.
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Primary survey and resuscitation
• Airway with cervical spine protection• Breathing and ventilation• Circulation and control of bleeding• Disability• exposure
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Adjuncts to the primary survey
• Full blood counts• Coagulation studies• Plasma chemistry• Transfusion screening• ECG
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• Radiography–Cervical spine–Chest–pelvis
• Urinary and gastric catheter
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Secondary survey
• Head and face• Neck• Chest• Abdomen and pelvis• extremities
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Treatment for Burns
• Cover burns to minimize heat and fluid loss • WP burns require special management –Copious lavage and removal or particles and
debris
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–Rinse with 1% copper sulfate solution• Combines with phosphorous particles and impedes further
combustion
–Cardiac monitor • Hypokalemia and hyperphsophatemia common
–Use moistened face masks to protect from phosphorous pentoxide gas exposure
–Avoid use of flammable anesthetic agents and excessive oxygen
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Definitive care and transfer
• Golden hour concept• Transfer when haemodynamically and
cardiovascularly stable
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Summary -Management
• Assessment and resuscitation are vital. • Diagnostic delays must be avoided. • Organ specific diagnosis is not required.
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Guidelines for Admission
• High risk patients who require admission– Significant burns– Suspected air embolism–Radiation
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–Contamination–Abnormal vital signs–Abnormal lung examination findings–Clinical or radiographic evidence of
pulmonary contusion or pneumothorax–Abdominal pain or vomiting –Penetrating injuries to the thorax,
abdomen, neck, or cranial cavity
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Selected References
• Bailey & Love’s SHORT PRACTICE of SURGERY 26th EDITION
• www.trauma.org
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