1. Kerbala university / college of medicine
polytrauma
by:-
Hasanain g. Khudhair
Mays salim Mahdi
Zahraa Salman yaas
Kerbala university / college of medicine
department of surgery

2. polytrauma

3. Objective: 1-defenition 2-epidemiology 3-etiology 4-pathophysiology
5-type of shock in polytrauma
6-Mangment

4. definition
Polytrauma is a significant injury in at least two of the following six body regions:
Head , neck and cervical spine
Face
Chest and thoracic spine
Abdomen and lumbar spine
Limbs and bony pelvis
External (skin)
Significant injury in AIS>=3

5. Abbreviated injury score AIS >=3 injury severity score ISS >=16

6. The defenition of polytrauma expanded to include concurrent injury to two or more body parts or systems that result in cognitive ,physical ,psychological or other psychosocial impairment.
Ex : TBI in combination with other disabiling condition like amputation,auditory or visual impairment, PTSD and other mental condition

7. Criteria of polytrauma include any one of the following combination injury
Two major system injury + one major limb injury
One major system injury +two major limb injury
One major system injury + one open grade 3 skeletal injury
Unstable pelvis # with associated visceral injury

8. Etiology of polytrauma
RTA
Fall from height (blunt or penetrating
injury)
Assault-اعتداء
Airplane crashes ,train derailment
Blast
Thermal ,chemical injury

9. Polytrauma is the third most common cause of death in all age group
Polytrauma is the third most common cause of death in all age group first peak-major neurological or vascular injury 2-second peak-intracranial hematoma , major thoracic or abdominal injury 3-third peak-sepsis and multiple organ fail

10. pathophysiology of polytrauma: is complex phenomenon aiming at the restoration of homeostasis and preservation of life

11. SIRS

12. Type of shock in polytraumatized patient
1.Hemorrhagic shock
duo to loss blood voulme ,diagnosis based on vital sign and examination characterized by hypotention tachycardia and cold skin
2.neurogenic shock
duo to spinal cord injury that causes distribution of sympathetic outflow to heart and blood vessles characterized by hpotention .bradycardia .warm skin
3.hypoxic shock
4.septic shock

13. Phases of trauma care 1.prehospital care 2.emergency department
3.Rehabilitation
Prehospital care:
TRIAGE
Sorting and allocation of treatment to patient according the urgency of their need for care Should be performed rapidly

14. How to start triage

15. ATLS Primary survey Identify what is killing the patient.
Resuscitation
Treat what is killing the patient.
Secondary survey
Proceed to identify other injuries.
Definitive care
Develop a definitive management plan.

16. ATLS- PRIMARY SURVEY A – Airway maintenance & control of C.Spine.
B –Breathing & ventilation.
C– Circulation & haemorrhage control
D – Disability limitation
E –Exposure & environment.
F – Fracture stabilization, folly catheter.

17. ATLS- PRIMARY SURVEY A – Airway maintenance & Control of C.Spine
If conscious- Ask the pt’s name
If unconscious-Look for added sounds (stridor,cyanosis etc)
If the pt does not respond to any questions- resuscitate.
Always assume a cervical spine injury is
present

18. ATLS- PRIMARY SURVEY A-AIRWAY
Sequence of events:
chin lift
Jaw thrust
finger sweep suction
Oropharyngeal/ orotrachial tube Cricothyroidotomy
Trachiostomy

19. B- Breathing & ventilation
Primary Survey
B- Breathing & ventilation
Exposure
Inspection
Auscultation
Palpation
Pulse oximetry
The aim is to hunt out & treat the life threatening thoracic condns which include:

20. B- Breathing & ventilation
Primary Survey
B- Breathing & ventilation
life threatening thoracic conditions:
Tension Pneumothorax
Open pneumothorax
Flail segment
Cardiac tamponade

21. B- Breathing & ventilation
Primary Survey
B- Breathing & ventilation
Tension pneumothorax
C/F
Respiratory distress Tracheal deviation Diminished breath sounds Distended neck veins
Immediate needle thoracocentesis thro’ 2nd intercostal space in mid clavicular line reqd.

22. B- Breathing & ventilation
Primary Survey
B- Breathing & ventilation
Open pneumothorax: Sealing of the wound Tube thoracostomy
Flail segment:
Endotrachial intubation
Mechanical ventilation

23. B- Breathing & ventilation
Primary Survey
B- Breathing & ventilation
Cardiac tamponade
(almost always seen with a penetrating wound)
Beck’s triad:
Treatment: needle pericardiocentes
Thoracotomy

24. ATLS- Primary Survey C- Circulation and hemorrhage control
Assessment of blood loss
External or obvious Internal or covert
chest abdomen pelvis limbs
Resuscitation
Arrest bleeding
Obtain vascular access

25. ATLS- Primary Survey C- Circulation and hemorrhage control
Adults- 2 lit of Ringer lact soln as initial fluid challenge
Children- 20mg/kg of body wt
Response to initial fluid challenge:
Immediate & sustained return of vital signs.
Transient response with later deterioration
No improvement.

26. ATLS- Primary Survey C- Circulation and hemorrhage control
Immediate responders-<20% blood loss
Bleeding ceases spontaneously
Transient responders-
bleeding within body cavities
Surgical intervention reqd.
Non responders- <40%of blood vol lost require immediate surgery
Continued IV fluids detrimental

27. ATLS- Primary Survey C- Circulation and hemorrhage control
Estimation of blood loss

28. ATLS- Primary Survey D- Disability limitation
C.N.S. Rapid assessment of motor & sensory functions AVPU
A.-Alert
V.-Responds to Voice
P.-Responds to Pain
U.-Unresponsive Pupil.-Size and reaction

29. ATLS- Primary Survey D- Disability limitation
Remove remaining clothing
Prevent hypothermia

30. Transient responders Failure to respond
CRITICAL DECISIONS
Decision making
Responding well
Secondary assessment
Transient responders
Critical care unit
Failure to respond

31. Secondary survey (ATLS)
History
Examination
Investigation

32. Secondary survey (ATLS)
HEAD
NECK
THORAX
ABDOMIN
SPINAL INJURY