Multiple Trauma

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Multiple Trauma

• Cindy Fehr
• Fall 2005

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Trauma

• Blunt or penetrating external force exerted on
  the body resulting in injury
• leading cause of death within first 45 years of
  life in Canada
• If not death, major cause for permanent
  disability
• Costs society in terms of lost productivity,
  hospital days and life-long health care costs
  (11 total cost of health care)
• Largely preventable

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Background

• Trauma not new concept as long as there has
  been conflict, there has been trauma, injury
  death as a result
• Trauma care more focus since Vietnam war focus
  on immediate management for better patient
  outcomes
• Continual research re value in lessening
  emergency response time and minimizing death
  disability rates as a result of health care
  interventions
• Trauma is complex and requires timely,
  coordinated treatment

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Epidemiology

• Blunt trauma
• associated with acceleration, deceleration,
  shearing, compression forces
• Traffic accidents, falls, sports injuries,
  explosions
• Most common cause of traumatic injury
• Penetrating trauma
• Due to object injuring skin, tissue, underlying
  organs, viscera, bone
• Any sharp object - knife, bullet, broken glass,
  impalement

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Traumatic Deaths

• Occur in three peak times
• Trauma care focused on preventing deaths and
  minimizing disability during these peaks
• Involves early recognition of life-threatening
  injuries, prompt treatment by appropriately
  trained health professionals

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First Peak

• Within seconds/minutes of injury
• Due to overwhelming unsalvageable injuries
• Major vessel, brain or very high spinal cord
  injury
• Prevention avoid injury from occurring
  altogether (seat belts, air bags, helmets,
  education re safety initiatives)

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Second Peak

• Minutes to hours after injury
• Due to hypoxia (and resulting acidosis), blood
  loss, hypovolemia, clotting disorders, severe
  head injuries
• Prevention rapid emergency response quick
  assessing, resuscitating getting to OR

8
Third Peak

• Hours, days or weeks after injury
• Due to complications from hypothermia, clotting
  disorders, sepsis, organ failure
• Prevention identify treat potential problems
  prevent secondary injury

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Primary Survey

• Initial assessment resuscitation
• Identify and quickly correct any life-threatening
  or limb-threatening injuries
• Completed in organized and sequential method
  (vertical organization)
• Each member of the trauma team has specific roles
  and responsibilities (horizontal organization)
• X-rays, lavages, CT scans

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ABCDE AMPLE

• A airway with spinal precautions
• B breathing and ventilation
• C circulation and control of deadly bleeding
• D disability and dysfunction
• E exposure environmental control
• A allergies
• M medications
• P pertinent past medical history
• L last food/drink
• E events leading to injury

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Secondary Survey

• Once hemodynamically stable sometimes only
  after OR in ICU
• To look for other less threatening injuries
• Includes CWMS of extremities
• Less obvious life-threatening musculoskeletal
  system injuries identified (deformities,
  hematomas, open wounds, ecchymosis, painful
  areas)

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Other Considerations

• Once neurological injury ruled out, can more
  easily medicate for pain ? can impact
  oxygenation, stabilization of injuries, can
  signal complication, recover quicker with
  adequate control
• Keep family/significant contact informed
• Document, document, document

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Potential Complications

• Hypovolemia
• Hypothermia
• Acidosis
• DIC (consumptive coagulopathy)
• Sepsis
• DVT PE
• Compartment Syndrome
• Fat Embolism
• Rhabdomyolysis (discussed in later wks)

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Temporary external fixation
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Balanced traction