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    Poly-Trauma: by Dr. Elias Ahmed October 2003

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    Sisay Fenta
    This document discusses poly-trauma, which is defined as injury to multiple organ systems or multiple organs within a system. Some key points: - Poly-trauma occurs worldwide and affects people of all demographics. Injuries are a leading cause of death globally. - The management of poly-trauma involves several phases: acute resuscitation, primary survey within 72 hours, secondary care from 3-8 days, and tertiary rehabilitation after 8 days. - During each phase, the focus is on stabilizing vital functions, identifying and treating injuries, preventing infection and further deterioration, and eventually facilitating recovery through reconstruction and rehabilitation. Timely and appropriate treatment across all phases is important for outcomes

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    Poly-Trauma: by Dr. Elias Ahmed October 2003

    Uploaded by

    Sisay Fenta
    68 views14 pages
    This document discusses poly-trauma, which is defined as injury to multiple organ systems or multiple organs within a system. Some key points: - Poly-trauma occurs worldwide and affects people of all demographics. Injuries are a leading cause of death globally. - The management of poly-trauma involves several phases: acute resuscitation, primary survey within 72 hours, secondary care from 3-8 days, and tertiary rehabilitation after 8 days. - During each phase, the focus is on stabilizing vital functions, identifying and treating injuries, preventing infection and further deterioration, and eventually facilitating recovery through reconstruction and rehabilitation. Timely and appropriate treatment across all phases is important for outcomes

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    Trauma

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    polytrauma

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    This document discusses poly-trauma, which is defined as injury to multiple organ systems or multiple organs within a system. Some key points: - Poly-trauma occurs worldwide and affects people of all demographics. Injuries are a leading cause of death globally. - The management of poly-trauma involves several phases: acute resuscitation, primary survey within 72 hours, secondary care from 3-8 days, and tertiary rehabilitation after 8 days. - During each phase, the focus is on stabilizing vital functions, identifying and treating injuries, preventing infection and further deterioration, and eventually facilitating recovery through reconstruction and rehabilitation. Timely and appropriate treatment across all phases is important for outcomes

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    68 views14 pages

    Poly-Trauma: by Dr. Elias Ahmed October 2003

    Uploaded by

    Sisay Fenta
    This document discusses poly-trauma, which is defined as injury to multiple organ systems or multiple organs within a system. Some key points: - Poly-trauma occurs worldwide and affects people of all demographics. Injuries are a leading cause of death globally. - The management of poly-trauma involves several phases: acute resuscitation, primary survey within 72 hours, secondary care from 3-8 days, and tertiary rehabilitation after 8 days. - During each phase, the focus is on stabilizing vital functions, identifying and treating injuries, preventing infection and further deterioration, and eventually facilitating recovery through reconstruction and rehabilitation. Timely and appropriate treatment across all phases is important for outcomes

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 14

    Poly-trauma

    By Dr. Elias Ahmed


    October 2003
    Definition
    • Injury to multiple organ system or multiple
    organ with in a system.
    • Two or more lesion that can affect the
    course of circulatory or respiratory function.
    Epidemiology
    • Occurs in all regions & countries.
    • Affect both sex, all age & income groups.
    • 16,000 people die every day world wide.
    • For each death, 400 non-fatal injuries & 80 – 100 disability.
    • In US 50 million injuries, 140,000 death & 80,000 permanent
    disability per year. Occupies > 12% of hospital bed.
    • 7- 8 million injuries /year in Germen.
     Injuries are leading cause of death in all age groups.
    esp. RTA & self-inflicted world wide. War in Africa.
    • Ethiopia 1992-96 6,017 RTA & 1,268 death in A.A

    1997-98 5,519 RTA & 1,313 death, 50% in A.A


    Characteristic Phasic patterns of Trauma Deaths

    • 20-30% of deaths are


    avoidable with
    Infection &
    MOF
    proper treatment.
    1-6wks
    Late • Time is extremely
    20% CNS, heart or
    great vessle important factor in
    injury
    0-1h determining the out
    Major
    heamorage
    Immediate
    50% come.
    1-4h
    Early • Clear recognition of
    30%
    Mx priorities are
    essential.
    Pathophysiology
    • Initiating factors:
    – Hypovolumia, K+, IL, PG, His, Ki, & Afferent Impulse.
    • Response is Dose dependent and protective.
    • Adjustment focus on:-
    – volume loss, perfusion, intermediate metabolism, tissue healing,
    infection response & stress adjustment.
    • Response depends on
    – age, nutritional & organ status, muscle bulk, fat store, blood volume,
    presence of infection and psychological status.
    • Neuro-endocrine are responsible for most of the response.
    Response to trauma
    1. Cell damage- release e-(k+ & po4) ,fluid, carbohydrate & protein.
    2. Neuro-endocrine response. ADH, ACTH, Catecholamine,
    Cortisone, Aldosteron, I/G and Gonadal hormone.
    3. Conservation of ECF.
    4. Change energy source.
    5. Acid-base balance
    6. Organ function –
    1. CVS
    2. RS
    3. GIT
    4. Kidney
    5. Brain
    phase of convalescence from trauma
    • EBB phase
    – Adrino-corticoid response.
      CO or shock, BMR, T°,  PH.
    – Immediate – reversing the shock state. Depends on resuscitation.
    • Active flow phase
      CO,  BMR,
      Catechols, low I/G  Hyperglycemia.
      lipolysis, gluconeogenesis
      Catabolism.
    • Adaptive phase
      Glucocorticoid , N I/G, Hyperglycemia
      Lipolysis
    – LBM and muscle strength become normal.
      Anabolic
    Trauma management
    1. Acute period or Resuscitation (1-3h)
    1. Rapid over. 3-5 sec. Look for
    • Means of ventilatory or cardiac support suggest the pt is
    • Pts color stable
    • Gross asymmetry unstable
      body movement dying or died
    2. Primary survey - basic physiological support. ABCDE
    i. Air way - assure or establishment & maintain.
    – Awake & answer question  adequate air way.
    – Unconscious  chin lift & forward jaw, sucker, finger sweep, place air way
    – Severe facial or neck injury  early intubation.
    ii. Breathing - guarantee optimal oxygenation.
    • I- RR, use of accessory muscle, symmetry of chest movement, sucking wound,
    distended neck vein.
    • P- position of trachea, crepitance, chest wall deformity.
    • A- air entry, bowel sound.
    • Alert pt taking deep breath with out discomfort  no respiratory compromise.
    – Continuous measure of oxygen saturation.
    – Pt with hypoxia secondary to pulmonary contusion should be intubated as soon
    as possible.
    – After intubation – standard principles of ventilation therapy
     PEEP & High TV 7-8 ml/kg.
    iii. Circulation – concerns are
    • External bleeding. Control rapidly.
    • BP, PR & pulse character, skin condition, mental status
    • Volume (shock)
    Assessment, access, fluid & monitor.
    • Pump problems
    Tension pneumothorax, pericardial tamponad, myocardial contusion,
    cardiac arrest, MI, coronary air embolism.
    iv. Disability – neurological evaluation
    • A- alert
    • V- response to verbal stimuli
    • P- response to pain full stimuli
    • U- unresponsiveness
    v. Exposure – look for missed or occult injury.
    • Remove all clothes
    • Avoid excessive movement.
    • Provide protection to prevent hypothermia.

    3. Resuscitation
    a. All pt should be with supplemental oxygen by face mask.
    b. IV - access
    c. Obtain blood sample.
    d. Fluid resuscitation
    e. Place air way in unconscious pt.
    f. Intubation & ventilatory support if indicated.
    4. Life saving surgery
    a. Massive hemorrhage
    b. Intra-cranial hemorrhage
    2. Primary period ( first 72h )
    • Start after all vital function have established.
    i. Secondary survey. Complete problem list. Took 5-10 min.
    a. Hx AMPLE ( allergies, medication, past illness, last meal & events of accident)
    b. P/E
    • Head, eye, ear, neck, chest, abdomen, GUS, extremity and neurology.
    c. insert monitoring equipment
    • Start ECG monitor,
    • Insert NG-tube and catheter.
    d. Early consultation is a rule in trauma care.
    e. Diagnostic studies
    – Lab. Hct, Bg & cross match, others
    – Lavage- for blunt abdominal injury – simple rapid & cheap.
    – Rose color, hct >1, >75000 RBC/ml, >500 wbc/ml , presence of bile or intestinal content.
    – X-ray
    – Contrast study
    – CT-scan
    2. Advanced cardiovascular measure like APA in pt with prolonged
    shock, thoracic trauma.
    3. General consideration
    i. Prophylaxis against infection or pre operative antibiotics.
    ii. Tetanus prophylaxis
    iii. Control pain.
    4. Delayed primary or day one surgery
    i. Cerebral injury
    ii. Eye & maxillo-facial injury.
    iii. Progressive compression of spinal cord.
    iv. Visceral injury.
    v. Musculoskeletal injury
    3. Secondary period ( 3-8 days)

    • phase of regeneration.
    • Secondary deterioration of organ function must be prevented by
    – Evacuation of hematoma.
    – Extensive debridement of ST necrosis.
    – Elimination of septic focus.
    • Reconstructive treatment
    – Secondary closure
    – ST reconstruction
    – Osteosynthesis of upper extremity
    – Complex joint reconstruction
    4. Tertiary period ( after 8 day)
    • Recovery continued
    • Final reconstructive surgery.
    – Bone graft.
    – Closure of amputation stamp
    – All operation postponed from secondary period.
    • Weaned from respiratory support
    • Cessation of sedation.
    • Program of physical rehabilitation.

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