It is also known as multiple trauma.
It occurs in civil medicine, usually due to a car accident. It is also common in military treatment in which men and women are subjected to mortar blasts and shelling.
Multiple trauma occurs when the patient sustains severe physical injuries simultaneously to various body areas.
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 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 challenging 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 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
The forces involved and the mechanism of injury determines the type of injuries a person receives. The power 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 power.
- Radiant energy: being exposed to radiation.
- Exposure to chemical energy to acids or bases.
- Electric power – being electrocuted.
- Oxygen deprivation: drowning or inhalation of smoke.
Several different mechanisms of injury may be involved simultaneously, 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 simultaneously. 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.
Several things predict the presence of a severe 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 ten 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 locations are involved. The main areas of the body involved in various trauma include:
- Head: This can consist of 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 an apparent injury. X-rays and other diagnoses can eliminate injuries that cannot be seen with the naked eye.
Physicians who care for trauma patients use an injury severity score to identify the patient’s degree of injury. The score ranges from 0-75 and evaluates a 0-6 in several 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 damage 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 the difference when caring for multiple trauma patients. 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 essential part of therapy to treat hypovolemia, common in patients with multiple trauma.