What Is Polytrauma?

Multiple injuries refer to the trauma caused by two or more anatomical parts or organs of the body under the action of the same trauma factor, at least one of which can be life threatening. Multiple injuries are different from multiple injuries, the former is that two or more anatomical parts or organs have suffered severe trauma, and the latter is that the same part or organ has more than two injuries.

Basic Information

Visiting department

General Surgery

Common causes

It is common in traffic accidents, explosive accidents, mine accidents, high falls, etc. Some patients also suffer multiple injuries when they fall on the ground or fall off a bicycle.

Common symptoms

Multiple injuries, multiple wounds, severe injuries, severe tissue damage, often accompanied by hemorrhagic or traumatic shock, immune dysfunction, and high metabolic status

Causes of multiple injuries

It is common in traffic accidents, explosive accidents, mine accidents, falling from heights, etc. Some patients also suffer multiple injuries when they fall on flat ground and fall from bicycles. Multiple injuries include multiple trauma sites, severe injuries, and severe tissue damage, often with hemorrhagic or traumatic shock, immune dysfunction, high metabolic status, and even multiple organ dysfunction syndrome (MODS).

Clinical manifestations of multiple injuries

The clinical manifestations are closely related to the location of the injury. For example, head trauma is mainly manifested by changes in consciousness, and coma may occur in severe cases; facial and neck trauma can cause airway obstruction and suffocation; the most common manifestation of chest trauma is rib fracture Blood pneumothorax and lung contusion; multiple abdominal injuries are common in internal bleeding caused by parenchymal rupture of organs, and peritonitis formed by rupture of cavity organs. In addition, multiple injuries are prone to cause hemorrhagic or traumatic shock, severe hypoxemia, cardiac tamponade, traumatic myocarditis, infection, and MODS. The clinical features of multiple injuries are as follows.
1. Injuries change rapidly and high mortality. Multiple injuries seriously affect the body's physiological functions. The body is in a state of overall stress. The mutual effects of trauma in several parts can easily lead to rapid deterioration of the injury and serious pathophysiological disorders. life. The main causes of multiple injuries are severe head injury and chest injury.
2. Severe injuries, high shock rates, multiple injuries, severe injuries, large injuries, extensive bleeding, and can even directly interfere with respiratory and circulatory system functions and threaten lives, especially the high incidence of shock.
3. The common characteristics of complex injuries and easy to miss multiple injuries are multiple injuries, complex injuries, obvious trauma and concealed trauma coexist, open injuries and closed injuries coexist, and most of the wounded cannot describe the injury, plus Each specialist pays more attention to the injury of the specialty, and ignores the diagnosis of the other department and misses the diagnosis.
4. Injury is complex and conflicts are dealt with. Multiple injuries often require surgery, but there are still contradictions in the sequence of operations. Without experience, I don't know where to start. At this time, the medical staff must decide the sequence of the surgical site according to the injuries of each part, the degree of life, the different organs involved, and the depth of the tissue, so as not to miss the rescue opportunity.
5. Low resistance and susceptibility to infection Multiple wounded patients generally have low resistance when under stress, and most of them are open wounds, and some wounds are particularly contaminated and extremely vulnerable to infection.
Multiple injuries had three peaks of death.
First death peak: Appears within minutes of injury and is an immediate death. The main cause of death is severe trauma to the brain, brain stem, high spinal cord, or torn large blood vessels such as the aorta of the heart, which is often too late to be rescued; the second peak of death: appears within 6 to 8 hours after injury, this time is called rescue In the "golden time", the causes of death were mainly intracerebral, subdural and epidural hematomas, hemopneumothorax, rupture of the liver and spleen, pelvic and femoral fractures, and multiple major bleeding. If prompt and timely, and appropriate rescue measures, most patients can be saved from death. This group of patients is the main target of rescue; the third peak of death: appears in the days or weeks after injury, the cause of death is severe infection or organ failure. Regardless of pre-hospital or intra-hospital rescue of patients with multiple injuries, care must be taken to prevent the third peak of death.

Multiple injury check

First of all, the injured should be checked quickly, especially the vital signs and bleeding of consciousness, complexion, breathing, blood pressure, pulse, pupil, etc., to confirm whether the injured has fatal injuries such as airway obstruction, shock, and major bleeding. Cardiopulmonary resuscitation should be performed immediately for patients with cardiac arrest and breathing; those with unconsciousness should keep the airway open, observe and record changes in the patient's consciousness, pupils, breathing, pulse and blood pressure. After the vital signs are stable, further ask the medical history. Carry out careful physical examinations, laboratory tests and special examinations to obtain the most accurate diagnosis possible. Multiple injuries are a kind of dynamic injuries with complex changes. The conclusions drawn from the initial examination may be incomplete and must be observed dynamically.

Multiple injuries diagnosis

Those who meet the following injuries 2 and above can be diagnosed as multiple injuries.
1. Skull injury: skull fracture, intracranial hematoma with coma, semi-coma, brain contusion, maxillofacial fracture.
2. Neck injury: Neck trauma with large vessel injury, hematoma, and cervical spine injury.
3. Chest injury: multiple rib fractures, blood pneumothorax, lung contusion, rupture of heart, large blood vessels, trachea, diaphragmatic hernia.
4. Abdominal injury: bleeding in the abdominal cavity, rupture of abdominal organs, and large retroperitoneal hematoma.
5. Urogenital system damage: kidney rupture, bladder rupture, uterine rupture, urethral rupture, vaginal rupture, etc.
6. Complex pelvic fracture or shock.
7. Spinal fracture, dislocation with spinal cord injury or multiple spinal fractures.
8. Limb injury: upper shoulder scapula, long bone fracture, upper limb detachment; lower tubular bone fracture of lower limb, lower limb detachment; extensive skin avulsion of limbs. Simple vertebral compression fractures, mild soft tissue contusions, hand and foot fractures, etc. should not be diagnosed as multiple injuries because they have little effect on the overall.

Multiple injuries treatment

1. The principle of emergency rescue (1) Diagnosis after treatment, diagnosis while processing.
(2) Severe situations that can be fatal quickly and reversible are dealt with first.
1) The upper respiratory tract obstruction is the most common in ventilation disorders. If the obstruction cannot be lifted in time, any rescue will not help.
2) Circulatory disorders: Hypovolemia: Multiple injuries and bleeding are very common. Both internal and external bleeding can cause hypovolemic shock. If the rescue measures are inadequate, it will enter an irreversible state, and death is inevitable; Heart failure and cardiac arrest: The sudden blow of multiple injuries can lead to cardiac arrest, and can also cause heart failure by many other comprehensive factors. The situation can be handled in time, and most of them can be quickly reversed. Tensile pneumothorax: Due to the obvious pressure of the chest gas on the heart and lungs, it can seriously interfere with breathing and circulation and can cause death quickly; Open pneumothorax: Open pneumothorax makes the mediastinum Swing back and forth, severely interfere with cardiopulmonary function and cause death; flail chest: due to multiple and multiple rib fractures, the local chest wall loses the stent function, which forms an abnormal movement relative to respiratory movement, which seriously affects cardiopulmonary function and causes death; pericardial tamponade: pericardial tamponade Significantly affects venous return, and the amount of cardiac output is severely insufficient, leading to death.
3) Bleeding is not only internal bleeding or external bleeding, if the bleeding is more than large and the amount of bleeding is also the cause of death. During on-site emergency treatment, if the blood pressure cannot be improved after a large amount of blood volume is supplemented, the possibility of bleeding is to be considered, and the cause should be investigated: check the wound and whether the external bleeding has stopped; whether there is chest bleeding, such as rupture of blood vessels in the chest wall; whether There is intra-abdominal hemorrhage, such as rupture of liver and spleen; Whether there is retroperitoneal hemorrhage, such as kidney injury, pelvic fracture, etc .; Extremity fractures, if large blood vessels are injured, the amount of bleeding is large, large hematomas are formed locally, and the hematomas will continue to expand.
2. Treatment of damaged organs after vital signs are stabilized (1) Craniocerebral injury: Pay attention to prevent cerebral edema, limit the amount of infusion, and remove intracranial hematoma as soon as possible.
(2) Chest injury: Ventilator positive pressure ventilation, bloody pneumothorax for closed chest drainage; heart injury should be repaired in time.
(3) Abdominal injury: deal with the injured organs, and perform laparotomy if necessary.
(4) Injury of limbs, pelvis and spinal cord: early debridement and fixed fractures, combined with vascular, nerve and pelvic internal organ damage, early surgical treatment.
3. Principles of surgical treatment The surgical order is mainly determined by the severity and importance of the injured organ, and it is generally performed in the order of emergency, acute and elective.