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Multiple Traumas

The document discusses the definitions, triage, and management of multiple traumas, specifically polytrauma, which involves severe injuries across multiple body systems. It outlines various trauma scoring systems, the importance of triage in emergency services, and the Advanced Trauma Life Support (ATLS) protocol for managing life-threatening injuries. Key strategies for treatment include Damage Control Orthopaedics and Early Total Care, emphasizing the need for effective resuscitation and prioritization of care.

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Chukwu Jeff
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5 views18 pages

Multiple Traumas

The document discusses the definitions, triage, and management of multiple traumas, specifically polytrauma, which involves severe injuries across multiple body systems. It outlines various trauma scoring systems, the importance of triage in emergency services, and the Advanced Trauma Life Support (ATLS) protocol for managing life-threatening injuries. Key strategies for treatment include Damage Control Orthopaedics and Early Total Care, emphasizing the need for effective resuscitation and prioritization of care.

Uploaded by

Chukwu Jeff
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MULTIPLE TRAUMAS;

DEFINITIONS, TRIAGE
AND MANAGEMENT OF
THE INJURED PERSON/
ATLS
Dr Peace Ifeoma AMARAEGBULAM
Multiple Traumas: Definition
◦Polytrauma: Cases with an Abbreviated Injury Scale (AIS) ≥
3 for two or more different body regions and one or more
additional variables from five physiologic parameters
(hypotension [systolic blood pressure ≤ 90 mmHg],
unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis
[base excess ≤ −6.0], coagulopathy [partial thromboplastin
time ≥ 40 s or international normalized ratio ≥ 1.4], and age
[≥70 years]).
◦Simply put, it is high energy trauma to more than one body
system.
Definition (contd)
◦Multiply injured patient: one or more severe
injuries to one body system.
◦An example is a patient with fractures to
bones on different parts of the body.
Trauma Scoring Systems
◦Abbreviated Injury Scale
◦Injury Severity Score
◦Revised Trauma Score
◦Glasgow Trauma Score
◦Abdominal Trauma Index
Abbreviated Injury Scale
◦The AIS is an
anatomically-based
injury severity scoring
system.
◦It classifies each injury
by body region on a six
point scale.
Injury Severity Score
◦The sum of the squares of the three highest AIS scores.
◦The highest score is 75.
◦If a region scores 6 on the AIS, then the ISS becomes 75.
◦The ISS body regions include head and neck injuries,
facial injuries, chest injuries, abdominal or pelvic
contents, extremities or pelvic girdle injuries, external
and other trauma injuries.
Revised Trauma Score
◦Measures the functional consequences of
injuries.
◦It uses three specific physiologic parameters:
 the Glasgow Coma Scale (GCS),
 systemic blood pressure (SBP), and
the respiratory rate (RR)
Glasgow Coma Scale
Mass Casualty
◦Refers to the situation where the number of patients
overwhelms the health resources available at the
local facility.
◦This depends on the local resources and capabilities.
◦The goal of treatment is “to do the most good for
the most people.”
Triage
◦The term triage originated from the French verb
trier which means to sort.
◦It functions to identify and prioritize those with the
most urgent needs to use the emergency service
first.
◦May be a 3-level triage.
◦May also use the colour coding.
ATLS ( Advanced Trauma Life
Support)
◦Life-threatening and high energy injuries require
resuscitation as a priority.
◦The Lethal Six (airway obstruction, tension
pneumothorax, cardiac tamponade, open
pneumothorax, massive hemothorax, and flail chest).
◦Other causes are respiratory failure, severe traumatic
brain injuries, haemoorhagic shock, etc.
Advanced Trauma Life Support
◦Consists of the:
Primary survey: a quick way to identify actual or
impending life-threatening injuries.
Follows the sequence of ABC.
Recognizing shock is critical.
Resuscitation. Uses crystalloids and blood/ blood
products. Start with 1-1.5L of warmed crystalloids.
Assess the vital signs as you go.
Classes of shock
ATLS (contd)
Secondary survey: head-to-toe examination to
identify missed injuries.
The Hidden Six (thoracic aortic disruption,
tracheobronchial disruption, myocardial contusion,
traumatic diaphragmatic tear, esophageal disruption,
and pulmonary contusion) are often identified here.
ATLS (contd)
◦Tertiary survey: A complete examination of the patient
and a review of the patient’s investigations since the time
of admission.
◦Aims to reassess identified injuries, confirm or exclude
suspected injuries or identify undiagnosed injuries.
◦Happens when the patient remains at the same center.
◦Definitive treatment or transfer to a higher center.
◦Depends on identified injuries and equipment at the center.
Damage Control Orthopaedics
◦This is a strategy is indicated in hemodynamically
unstable trauma patients with long bone fractures,
unstable pelvic fractures and/or massive
hemorrhage.
◦Achieves early physiological stabilization using
temporary manouevres like external fixators.
◦It is useful to control the lethal triad of hypothermia,
acidosis and coagulopathy.
Early Total (Definitive) Care
◦Entails fracture fixation in one trip to the OR during
the early phase of the treatment.
◦Multi-injured patients treated with ETC appeared to
have less pulmonary complications, reduced length
of intensive care unit (ICU) and hospital stay (LOS),
compared to patients with delayed surgery.
◦Made possible by improvements in osteosynthesis
techniques and trauma resuscitation.
Take Home Messages
◦Polytrauma is a leading cause of death in our
environment.
◦Triage and resuscitation are key concepts in the
management of polytrauma.
◦The ATLS protocol is essential in the resuscitation of the
trauma patient.
◦Early Total Care and Damage Control Orthopaedics are two
key management strategies.

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