It is also known as multiple trauma.
It occurs in civil medicine, usually as a result of a car accident. It is also common in military medicine in which men and women are subjected to mortar blasts and shelling.
Multiple trauma or multiple trauma occurs when the patient sustains severe physical injuries at the same time to multiple areas of the body.
Different organs and systems of the body are injured, including head injuries, fractures, and internal injuries to the abdomen or chest. The more body systems involved in the trauma, the more serious the injury.
The trauma can be blunt trauma or penetrating trauma , or both. Blunt trauma occurs in things like car accidents and when you fall from a great height.
Penetrating trauma usually occurs as a result of a puncture or gunshot wound. The body is pierced by something and areas of the body are traumatized. Blunt force trauma is often more difficult to diagnose than penetrating trauma because the injuries are internal and are not easy to see with the naked eye.
More than 90% of these types of injury deaths occur in poor and middle-income countries.
Eastern European countries have the highest rate. Men have the highest rate of deaths from multiple trauma with a death rate twice that of women.
Half of all deaths are due to violence, such as self-inflicted violence, war-related, and interpersonal violence. The next highest polytrauma death rate includes traffic-related deaths. It is the highest rate of deaths and hospital admissions for polytrauma in advanced nations.
Types of injury
It is the forces involved and the mechanism of injury that determine the type of injuries a person receives. The force comes from the environment and there is a transfer of kinetic energy to the tissues, which causes the injury. The following are the various types of injury mechanisms in multiple trauma:
- Thermal or cold energy: frostbite or burns.
- Mechanical damage: blunt force energy or penetrating energy.
- Radiant energy: being exposed to radiation.
- Exposure to chemical energy to acids or bases.
- Electric energy – being electrocuted.
- Oxygen deprivation: drowning or inhalation of smoke.
Several different mechanisms of injury may be involved at the same time, depending on the circumstances.
Causes of polytrauma
Multiple trauma can be due to many things. The most common is a car accident. There is usually a blunt force acting on the whole body at the same time. Other causes of multiple trauma include:
- Combat-related injuries.
- Bullet wounds.
- Knife wounds.
- Fall from a great height.
People most at risk for multiple trauma include:
- Male gender.
- People under the influence of alcohol or drugs.
- People over 60 years.
- People with emotional, mental or physical problems.
There are several things that predict the presence of a serious injury. The physician must observe these things to raise the index of suspicion that multiple trauma has occurred:
- Systolic blood pressure less than 90 mmHg.
- Respiratory rate less than 10 or greater than 29 per minute.
- Prolonged pre-hospital time of more than 30 minutes.
- Glasgow coma scale value of less than 13.
- Pedestrian hit at more than 20 miles per hour.
- Adults over 40 years of age.
- Underlying chronic diseases
Multiple trauma can have different symptoms depending on which area of the body or areas are involved. The main areas of the body involved in multiple trauma include:
- Head: This can include a brain hemorrhage or brain injury.
- Facial trauma can include fractures and lacerations.
- Spine: There may be vertebral fractures or damage to the spinal cord.
- Extremities: There may be fractures or neurovascular injury to the extremities.
- Chest: This may include a cardiac contusion or a puncture from lung and rib fractures.
- Damage to the internal organ of the abdomen can occur with blunt or penetrating trauma.
- Pelvic injuries can involve soft tissue or bone injuries.
- Skin – Skin can be frozen, burned, or lacerated.
Diagnosis of polytrauma
The diagnosis of multiple trauma is made with a careful history and physical examination, taking into account areas of obvious injury. X-rays and other diagnoses can be done to eliminate injuries that cannot be seen with the naked eye.
Physicians who care for trauma patients use an injury severity score to identify the degree to which the patient is injured. The score ranges from 0-75 and evaluates a score of 0-6 in several different body areas. Areas include:
- Head and neck.
A score of 0 in any category means there is no injury. A score of 6 means that the injury cannot be saved.
Traumatic injuries are first treated with the airway, breathing, and circulation. These must be addressed before the patient’s other injuries are attended to.
This can mean many things. For example, a fracture may be viewed as a tertiary treatment option, but becomes primary if the patient has life-threatening bleeding from the fracture.
Referral to the trauma center makes all the difference in the world when it comes to caring for a multiple trauma patient. The theoretical order in which patients should be treated includes:
- Circulation, cervical and lumbar spine, cardiac status.
- Disability, neurological deficit.
- Fluid resuscitation.
A complete evaluation of the patient and prioritization of the treatment of the lesions is needed. Aggressive fluid resuscitation is an important part of therapy to treat hypovolemia, which is common in patients with multiple trauma.
After immediate resuscitation measures are performed, there are other things to consider, including reducing the risk of infection and treating various injuries. Nutritional management is also important in how well a patient does in healing.