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Polytrauma can be caused by motor vehicle accidents, falls from heights, bullet injuries, blast injuries caused by explosive devices, etc.
Polytrauma is a medical term used to describe someone who has been subjected to multiple traumatic injuries. Polytrauma can be caused by motor vehicle accidents, falls from heights, bullet injuries, blast injuries caused by explosive devices, etc.
How soon should polytrauma be treated?
Treatment is crucial within the first hour of trauma, because the majority of deaths from polytrauma are likely to occur during this period.
Immediate and early deaths account for nearly 80% of trauma deaths, usually as a result of traumatic brain injury or severe loss of blood. Late deaths occur within days or weeks of the initial injury and are generally due to multiorgan failure.
How is polytrauma treated?
Most patients with polytrauma land in the emergency department. The trauma team aims to identify problems and priorities, stabilize the patient, then transfer the patient to the care of a team of specialists.
Emergency management involves:
- Airway management
- Breathing and ventilation
- Circulation
- Hemorrhage control
- Disability
- Exposure/environment
Airway management (including cervical spine protection)
Airway assessment is a priority in the management of polytrauma patients and involves planning a series of medical procedures required to maintain or restore the patient’s breathing. The trauma team will initially try simple maneuvers for this purpose, including chin lift/jaw thrust. They will also check for signs of cervical injury.
The trauma team often performs intubation in patients who are unable to breathe. Intubation is a bedside procedure in which a tube is inserted into either the nose or the mouth to help the patient breathe. Intubation through the mouth is known as orotracheal intubation and intubation through the nose is known as nasotracheal intubation.
Patients with upper airway obstruction in which an endotracheal tube cannot be passed through the vocal cords will require a surgical procedure known as cricothyroidotomy or tracheostomy. The goal of surgery is to provide patients with supplemental oxygen while a definitive airway is secured. It involves placing a wide-bore cannula into the windpipe (trachea) by making an incision into the neck. The patient is then connected to an oxygen source and manually ventilated for 30-45 minutes.
Breathing and ventilation
The trauma team checks for breathing and air entry by listening to breathing sounds and observing chest movement. The patient’s clothes are removed to observe their respiratory rate, breathing, and chest symmetry, and the chest and axillae are examined for abrasions, bruising, open wounds, and signs of penetrating trauma.
Several serious chest injuries such as hemothorax or pneumothorax can be detected with this type of physical exam:
- Hemothorax is a collection of blood in the space between the chest wall and lung (the pleural cavity).
- Pneumothorax is the presence of air or gas in the cavity between the lungs and chest wall.
Surgery may be performed if pneumothorax or hemothorax is suspected. Chest X-rays or ultrasound of the chest may be ordered to confirm a diagnosis if needed.
If these conditions are left untreated, or if there is a significant delay in treatment, they can lead to decreased oxygenation (hypoxia) or low blood volume (hypovolemia) and turn life-threatening.
Circulation
Polytrauma often results in severe bleeding, which in turn can lead to hypovolemic shock. Hypovolemic shock is an emergency condition in which severe blood loss or other fluid loss leads to the inability of the heart to pump enough blood to the body. Clinical signs of hypovolemic shock include:
- Tachycardia (rapid heart rate)
- Increased respiratory rate
- Cold limbs
- Drop in consciousness
Treatment of hypovolemic shock requires intravenous administration of fluids such as electrolyte solutions, salt solutions, or blood/blood components.
Hemorrhage control
The trauma team will try to control the source of bleeding from external wounds to stop further blood loss. This requires pressure application on bleeding wounds.
Another option is the use of tourniquets, which are designed to occlude arterial flow to a limb through compression. They are usually applied 10 cm proximal to the injury, directly on top of the skin, and not over a joint for up to 2 hours.
Disability
Polytrauma patients can sustain injuries to the spine that may result in lifelong disability. Appropriate neurological examination must be performed to identify such spinal injuries. If there is a suspected spinal injury, a spinal surgeon may be called in early.
Exposure/environment
After removing clothes for examination, patients should be actively warmed or covered with blankets to minimize heat loss and prevent body temperature from dropping too low. The patient may be transferred to the operation room, radiology department, or to another hospital.