TRIMODAL DEATH DISTRIBUTION 50% 40% 30% 20% 10% 0% HOURS 0 1 2 34WEEKS 12 3 4 TRIMODALBIMODAL? THE SECOND GROUP IS DECREASING DUE TO PROPER TREATMENT.

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Presentation transcript:

TRIMODAL DEATH DISTRIBUTION 50% 40% 30% 20% 10% 0% HOURS WEEKS TRIMODALBIMODAL? THE SECOND GROUP IS DECREASING DUE TO PROPER TREATMENT

DEFINITION OF POLYTRAUMA A. INJURY TO ONE OR MORE BODY REGIONS OR ORGANS OF WHICH ONE, OR THEIR COMBINATIONS IS LIFE THREATENING B.INJURY TO MORE BODY REGIONS FOLLOWING WHICH, DURING TREATMENT, WE HAVE TO MAKE COMPROMISES C.INJURY TO HOLLOW ORGANS + INJURY TO EXTREMITIES D.INJURY DEFINED BY SCORING SYSTEM

INJURY SEVERITY SCORE (ISS) SIX REGIONS THE THREE MOST SEVERE THE SQUARE OF EACH VALUE THE SUM OF THE RESULTS HEAD AND NECK FACE CHEST ABDOMEN EXTREMITIES (PELVIS) SKIN

DEFINITION OF POLYTRAUMA A. INJURY TO ONE OR MORE BODY REGIONS OR ORGANS OF WHICH ONE, OR THEIR COMBINATIONS IS LIFE THREATENING B.INJURY TO MORE BODY REGIONS FOLLOWING WHICH, DURING TREATMENT, WE HAVE TO MAKE COMPROMISES C.INJURY TO HOLLOW ORGANS + INJURY TO EXTREMITIES D.INJURY DEFINED BY SCORING SYSTEM

ATLS CONCEPTION ABCDE APPROACH FIRST THE LIFE THREATENING INJURY THE IMMEDIATE EXACT DIAGNOSIS IS NOT IMPORTANT THE TIME FACTOR IS THE MOST IMPORTANT DO NOT DO MORE HARM ATLS CONCEPTION ADVANCED TRAUMA LIFE SUPPORT ABCDE APPROACH FIRST THE LIFE THREATENING INJURY THE IMMEDIATE EXACT DIAGNOSIS IS NOT IMPORTANT THE TIME FACTOR IS THE MOST IMPORTANT DO NOT DO MORE HARM

THE CAUSE OF SHOCK BLEEDINGNON BLEEDING BLEEDINGTENSION PTX (FAST)CARDIAC TAMP. FOCUSEDCARDIOGENIC ASSESSMENTNEUROGENIC SONOGRAPHY inSEPTIC TRAUMA CHEST, PELVIS X-RAY

PATIENT RESPONSE „RAPID RESPONDER” CRISTALLOIDS „TRANSIENT RESPONDER” CRISTALLOIDS, TRANSFUSION PATIENT RESPONSE? „NON-RESPONDER” CRISTALLOID, IMMEDIATE TRANSFUS. SURGERY

SECONDARY SURVEY AMPLE AALLERGIES MMEDICATIONS PPAST ILLNESSES LLAST MEAL EEVENTS/ENVIRONMENT

THERAPEUTIC WINDOWS 1.FIRST 24 (48) HOURS DAYSFOLLOWING INJURY WEEKS ABDIMINAL THORACIC, BRAIN INJURIES EXTREMITIES VESSEL, NERVE INJURIES INTRAMEDULLARY STABILISATION EXTERNAL FIXATEUR

MOF AND SIRS MOF AND SIRS MULTIPLE ORGAN FAILURE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME MOF HYPOXIA, HYPOPERFUSION, („FIRST HIT”) BACTEREMIA TOXINS – BOWEL HYPOPERFUSION („SECOND HIT”) FRACTURE OF LONG TUBULAR BONES MEDIATORS SIRS TWO OR MORE OF THESE FACTORS FEVRE HIGHER THAN > 38 OR < 36 TACHYPNOE > 24/MIN TACHYCARDIA > 90/ MIN LEUCOCYTOSIS >12 000/ MM3 LEUCUPENIA > 4000 OR JUVENILE CELLS MORE THAN 10% SHOCK

TRIAGE A. DEGREE OF LIFE THREAT POSED BY THE INJURY INJURY B. INJURY SEVERITY C. SALVAGEABILITY D. RESOURCES AVAILABLE E. TIME, DISTANCE, ENVIRONMENT