1. Chapter 41 Multisystem Trauma
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2. Objectives
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3. Multisystem Trauma Multisystem trauma
Significant forces affect more than one area of the body at the same time
Examples
Head and spinal trauma
Chest and abdominal trauma
Burns and extremity trauma
An individual who has been subjected to significant forces that affect more than one area of the body at the same time is a victim of multi-system trauma (also called polytrauma). Typically, a patient who has multi-system trauma has more than one major body system or organ involved. For example, a patient may experience head and spinal trauma, chest and abdominal trauma, or burns and extremity trauma. Multi-system trauma should be suspected in any patient subjected to significant external forces.

4. Multisystem Trauma Greater risk of developing shock
High frequency of serious injury and death
Definitive care may include surgery
Short scene times and rapid transport to the closest appropriate facility are essential
You must know your local trauma system capabilities.
Patients who experience multi-system trauma are at a greater risk of developing shock and have a high frequency of serious injury and death. Definitive care for multi-system trauma may include surgery, which cannot be done in the field. Short scene times and rapid transport to the closest appropriate facility, such as a trauma center, are essential to help ensure a positive patient outcome. Hospital care for the multi-system trauma patient involves a team of physicians that may include specialists such as neurosurgeons, thoracic surgeons, and orthopedic surgeons. You must know your local trauma system capabilities in advance to determine the appropriate destination for the multi-system trauma patient.

5. Multisystem Trauma Conduct a scene size-up
Ensure your own safety because
Evaluate the mechanism of injury
Call for additional resources early
In multisystem trauma, call for ALS personnel right away.
In some situations, air medical transport may be necessary.
As with all emergency calls, conduct a scene size-up as you approach the scene to ensure your safety as well as that of your crew, bystanders, and the patient. It is essential to ensure your own safety because if you are injured you cannot provide needed care. Remember that a scene size up is an ongoing process and continues throughout any emergency scene. Evaluate the mechanism of injury, such as a motorcycle crash, motor vehicle collision, vehicle rollover, fall, shooting, or stabbing. Be sure to assess your environment for hazards or potential hazards such as passing automobiles, hazardous materials, hostile environment, unsecured crime scene, or a suicidal patient who may become homicidal. Call for additional resources early. When performing a scene size-up and recognizing that the mechanism of injury probably resulted in multi-system trauma, call for advanced life support personnel right away. In some situations, air medical transport may be necessary.

6. Principles of Prehospital Trauma Care
Safety of rescue personnel and patient
Wear appropriate personal protective equipment
Determination of additional resources
Assessment of mechanism of injury
Maintain a high index of suspicion

7. Principles of Prehospital Trauma Care
Airway management while maintaining cervical spine stabilization
Support oxygenation and ventilation
Oxygen saturation greater than 95%

8. Principles of Prehospital Trauma Care
Treat shock
Maintain normal body temperature
Splint musculoskeletal injuries
Maintain spinal stabilization on long backboard
Short scene time, rapid transport to closest appropriate facility

9. Principles of Prehospital Trauma Care
Obtain medical history
Secondary survey after treatment of life threats
Accurate, legible documentation

10. Blast Injuries

11. Blast Injuries Blast injuries Can produce multisystem trauma
Injuries result from pressure waves generated by an explosion
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Blast injuries are one mechanism of injury that can produce multi-system trauma. Blast injuries result from pressure waves generated by an explosion. When the explosion occurs, there is an immediate rise in pressure over the atmospheric pressure. This creates a blast (overpressurization) wave. Blast waves cause disruption of major blood vessels, rupture of major organs, and lethal cardiac disturbances when the victim is close to the blast. Blast winds (forced super-heated air flow) and ground shock can collapse buildings and cause trauma.

12. Blast Injuries Five categories: Primary blast injuries
Secondary blast injuries
Tertiary blast injuries
Quaternary blast injuries
Quinary blast injuries
Image source: Microsoft clipart
Blast injuries are one mechanism of injury that can produce multi-system trauma. Blast injuries result from pressure waves generated by an explosion. When the explosion occurs, there is an immediate rise in pressure over the atmospheric pressure. This creates a blast (overpressurization) wave. Blast waves cause disruption of major blood vessels, rupture of major organs, and lethal cardiac disturbances when the victim is close to the blast. Blast winds (forced super-heated air flow) and ground shock can collapse buildings and cause trauma.

13. Blast Injuries 1. Primary blast injury
Occurs from the blast wave impacting the body surface
Organs surrounded by fluid and organs filled with air are particularly susceptible to primary blast injury.
Image source: Microsoft clipart
A primary blast injury occurs from the blast wave impacting the body surface. Individuals closest to the explosion are at the greatest risk of injury. Organs surrounded by fluid (such as the brain and spinal cord) and organs filled with air (such as the middle ear, lungs, and gastrointestinal tract) are particularly susceptible to primary blast injury. The patient may report hearing loss, ear pain, or dizziness. Bleeding from the external ear canal may be present. Suspect a lung injury in anyone complaining of dyspnea, cough, hemoptysis, or chest pain following a blast. An abdominal injury should be suspected in anyone complaining of abdominal pain, nausea, vomiting, hematemesis, rectal pain, testicular pain, or who has unexplained hypovolemia. Consider the possibility of a traumatic brain injury if the victim complains of a headache, fatigue, poor concentration, lethargy, depression, anxiety, or insomnia.

14. Blast Injuries 2. Secondary blast injury Occurs from projectiles
Blunt and/or penetrating trauma
Open and closed brain injury
Extremity fractures
Bleeding
Shock
Lacerations of heart and great
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A secondary blast injury occurs from projectiles, such as bomb fragments, flying debris, and materials attached to the explosive device (such as screws or other small metal objects), resulting in blunt and/or penetrating trauma. The closer the person is to the site of the blast, the greater the injury. Most deaths in an explosion are due to secondary blast injuries. Injuries include open and closed brain injury, extremity fractures, bleeding, and shock. Lacerations of the heart and great vessels may also occur. A patient with a secondary blast injury also may have primary blast injuries.

15. Blast Injuries 3. Tertiary blast injury
Caused by an individual flying through the air
Victim may be thrown to the ground or through the air, striking other objects
Blunt and penetrating trauma
Fractures
Traumatic amputations
Image source: Microsoft clipart
A tertiary blast injury is caused by an individual flying through the air because of displacement from the blast wind. The victim may be thrown to the ground or through the air, striking other objects. Injuries include blunt and penetrating trauma, fractures, and traumatic amputations. A patient with a tertiary blast injury also may have primary and secondary blast injuries.

16. Blast Injuries 4. Quaternary blast injury
All other injuries from the blast
Burns
Crush injuries
Open and closed brain injuries
Respiratory illnesses related to dust, fumes, toxic smoke
Worsening of chronic illnesses
Image source: Microsoft clipart
A quaternary blast injury is all other injuries from the blast not categorized as a primary, secondary, or tertiary blast injury. Injuries include burns, crush injuries, open and closed brain injuries, respiratory illnesses related to dust, fumes, toxic smoke, and worsening of a chronic illness, such as asthma or chronic obstructive pulmonary disease.

17. Blast Injuries 5. Quinary blast injury
Results from absorption of toxic materials associated with the blast
Can include bacteria and radiation
A quinary blast injury results from absorption of toxic materials associated with the blast, which can include bacteria and radiation.

18. Blast Injuries Scene safety
If an Incident Management System has been established at the scene, report to the Command Post
A blast victim should be reassessed often
Transport as soon as possible to the closest appropriate facility
Scene safety is a concern at the site of any explosion and will likely require many additional resources. If an Incident Management System has been established at the scene, report to the command post and follow the directions given. If you are assigned to perform patient care, it is important to remember that a blast victim should be reassessed often and transported as soon as possible to the closest appropriate facility.

19. Questions?