Polytrauma

Polytrauma is also called multiple trauma. It occurs in civilian medicine, usually as a result of an automobile accident. It is also common in military medicine in which men and women are subject to mortar blasts and bombings.

Multiple trauma or polytrauma occurs when the patient suffers severe physical insults at the same time in multiple areas of the body. Different organs and body systems are injured, including head injuries, fractures and internal injuries to the abdomen or chest. The more body systems involved in trauma, the more serious the injury is.

Trauma can be blunt trauma or penetrating trauma or both. Blunt trauma happens in things like motor vehicle accidents and falls from a great height. Penetrating traumas usually occur as a result of a stabbing or gunshot injury. The body is pierced by something and areas of the body are traumatized. Blunt force trauma is usually harder to diagnose than penetrating trauma because the injuries are internal and not easy to see with the naked eye.

Trauma accounts for many deaths throughout the world—about 5 million people died worldwide. This involves about 9 percent of all deaths in the world. More than 90 percent of these types of injury deaths occur in poor and middle-income countries.

The Eastern European countries have the highest rate. Males have the highest rate of polytrauma deaths with a rate of death twice that of females. Half of all deaths are due to violence, such as self-inflicted, war-related and interpersonal violence. The next biggest rate of polytrauma death includes road-related traffic deaths. It is the highest rate of death and hospital admissions for polytrauma in advanced nations.

It’s the forces involved and the mechanism of injury that determines the type of injuries a person receives. The force comes from the environment and there is a transfer of kinetic energy into the tissues, which causes the injury. The following are the various types of mechanisms of injury in polytrauma:

• Thermal or cold energy—frostbite or being burned
• Mechanical injury—blunt force energy or penetrating energy
• Radiant energy—being exposed to radiation
• Chemical energy—exposure to acids or bases
• Electrical energy—being electrocuted
• Oxygen deprivation—drowning or smoke inhalation

Several different mechanisms of injury can be involved at the same time, depending on the circumstances.

Multiple trauma can be due to many things. The most common is an automobile accident. There is usually a severe blunt force that acts on the entire body at the same time. Other causes of polytrauma include:

• Combat-related injury
• Altercations
• Fires
• Gunshot wounds
• Knife wounds
• Falls from a great height

People at greater risk of suffering from poly trauma include:

• Male gender
• Children
• Adolescents
• Persons under the influence of alcohol or drugs
• People over the age of 60 years
• People with emotional, mental or physical problems

There are several things that predict the presence of a severe injury. The doctor must look at these things to raise the index of suspicion that multiple trauma has occurred:

• Systolic blood pressure less than 90 mmHg
• Respiratory rate of less than ten or greater than 29 per minute
• Prolonged prehospital time of greater than 30 minutes
• Glasgow coma scale value of less than 13.
• The pedestrian was struck at greater than 20 miles per hour
• Child under the age of 5 years
• Infants
• Adults over the age of 40 years
• Underlying chronic medical conditions

Multiple trauma can have different symptoms depending on what body area or areas are involved. The major body areas involved in multiple trauma include:

• Head—this can include brain hemorrhage or brain injury
• Face—facial trauma can include fractures and lacerations
• Spine—there can be vertebral fractures or damage to the spinal cord
• Extremities—there can be fractures or neurovascular injury to the extremities
• Chest—this can include a cardiac contusion or a punctured lung and rib fractures
• Abdomen—internal organ damage can happen with blunt or penetrating trauma
• Pelvis—pelvic injuries can involve soft tissues or bony injuries
• Skin—the skin can be frozen, burned or lacerated

The diagnosis of polytrauma is made with a careful history and physical examination, noting areas of obvious injury. X-rays and other diagnostics can be done to flush out injuries that can’t be seen by the naked eye.

Doctors caring for trauma patients use an Injury Severity Score to identify the degree to which the patient is injured. The score goes from 0-75 and assesses a score of 0-6 in several different bodily areas. The areas include:

• Head and neck
• Face
• Chest
• Abdomen
• Extremity
• External

A score of 0 in any category means there is no injury. A score of 6 means the injury is unsurvivable and brings the entire ISS to 75. The weakness of the ISS scoring is that the scores aren’t weighted so a variety of different types of injury can yield the same ISS score. Nevertheless, it is used for statistical analyses of injuries in research. An abbreviated ISS score is also used and is easier to use in triage of patients.

Traumatic injuries are first treated with the ABCs of emergency medicine—airway, breathing, and circulation. These should be addressed before the patient’s other injuries are taken care of. This can mean a lot of things. For example, a fracture may be seen as a tertiary treatment option but becomes primary if the patient has a hemorrhage from the fracture that is life threatening.

Referral to the trauma center makes all the difference in the world when it comes to taking care of a multiple trauma patient. In trauma, there are actually more letters after ABC and these include the following. In reality, these things are usually worked on all at the same time by a multitude of health care providers. The theoretical order that patients should be treated with include:

• Airway
• Breathing
• Circulation, Cervical and lumbar spine, Cardiac status
• Disability, Neurologic deficit
• Expose and examine
• Fluid resuscitation

It takes a complete assessment of the patient and prioritization of the treatment of injuries. Aggressive fluid resuscitation is an important part of the therapy so as to treat hypovolemia, which is common in multiple trauma patients. After immediate resuscitation measures are done, there are other things to consider, including lowering the risk of infection and the treatment of the various injuries. Nutritional management is also important in how well a patient does in healing.

If you or a loved one has suffered polytrauma as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 to set up a FREE consultation.