Polytraumatized Patient

Excerpt

The term "polytrauma" is used frequently in trauma practice and literature. It refers to multiple injuries that involve multiple organs or systems. This condition is in contrast to isolated trauma injury where there is a single injury encountered. The evaluation, management, and prognosis of polytraumas are significantly different from isolated injuries.

Polytrauma has a significant impact on the wellbeing and provided healthcare for the populations. Millions of patients seek medical help as a result of trauma, with a substantial proportion of patients suffering from life-changing or life-limiting injuries. The leading cause of traumatic death worldwide is road traffic collision, followed by suicide and homicide. Identifying the mortality patterns in trauma has been the driving force behind establishing trauma networks and major trauma centers in an attempt to improve management in the initial stages of traumatic injury. Professor Richard Cowley coined the phrase ‘The Golden Hour' following his observations in Baltimore, U.S.A., and the U.S. Army during the Second World War, where he concluded that the vast majority of deaths occurred in the first 60 minutes following injury.

Further research in the trauma deaths has resulted in the description of trauma deaths with a trimodal distribution. This model describes deaths following traumatic injury in three peaks; immediate, early, and late. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury, usually as a result of traumatic brain injury or major exsanguination. The late deaths occur within days or weeks of the initial injury and are generally secondary to multiorgan failure or sepsis.

Due to the high mortality and morbidity of trauma, medical professionals need to adopt the principles of an organized approach to the initial management of their patients. Management protocols are designed to help medical teams treating trauma patients with decision making and treatment promptly systematic approach, so that outcomes for patients may be improved. The primary survey follows the ABCDE system that includes assessment and management of Airway, Breathing, Circulation, Disability, and Exposure.