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POLYTRAUMA

Polytrauma has been studied separately for no more than 25-30 years The occurrence of polytrauma and the gravity of injury grows from year to year A lot of polytrauma cases are observed during natural disasters, industrial accidents and during acts of warfare

POLYTRAUMA
specific features mutual aggravation syndrome some sign typical of monotrauma are indistinct the classic manifestations of traumatic shock are absent

POLYTRAUMA
Multiple injury Associated injury

Combined injury

ASSOCIATED INJURY
An associated injury is a simultaneously inflicted lesion of two or more organs from different anatomical and physiological systems (the trauma of liver and lung, a brain contusion and rupture of kidney )

MULTIPLE INJURY

organs in one cavity are injured two or more anatomical-functional formations of the musculoskeletal system are injured vessels and nerves in different anatomical segments of extremities are injured

COMBINED INJURY
A combined injury is a combination of

two or more etiologically dissimilar injuries: fracture and burn, rupture of a parenchymatous organ and poisoning, mechanical injury and radiation sickness.

the technique of first aid in trauma


ensuring the patency of airways and adeuqte ventilation arrest of hemorrhage analgesia transportation immobilization early beginning of infusion therapy immediate transportation of the patient to hospital during which antishock measures should be continued

The factors of secondary brain injury

intracranial ones intracranial hypertension dislocation syndrome cerebral vasospasm cramp intracranial infection

The factors of secondary brain injury

extracranial ones arterial hypotension hypoxemia hypercapnia severe hypocapnia hyperthermia hyponatremia anemia disseminated vascular syndrome hypo- and hyperglycemia

classification of craniocerebral injury

brain concussion brain contusion compression of the brain

classification of craniocerebral injury

closed ones (when the scalp is intact) open ones (these are brain injuries with head wounds and damaged aponeurosis, fractures of cranial fornix with injury of adjacent soft tissues, fractures of cranial basis accompanied by bleeding from the ear and nose or liquorrhea)

Brain concussion
subjective signs of

headache nausea dizziness retrograde amnesia

Brain concussion

objective signs ear consciousness; short-time torpor is possible moderate arterial hypertension (if not observed earlier) labile tone of facial vessels (alternating pallor and hyperemia) infrequent vomiting

Brain contusion

mild (the period of unconsciousness is from several minutes to 2-3 hours ) medium (it can last from several hours to 2 days ) severe (the patient can stay unconscious for many days )

Brain contusion

reliable criteria for diagnosing when survey radiography of the skull reveals fractures of cranial fornix or clinical signs of fracture of cranial basis the presence of blood in cerebrospinal fluid (the spinal puncture in craniocerebral injury has to have strict indications) computer tomography and magnetic resonance imaging give reliable information about the patients condition

.N. Konovalovs classification of the infringement of the consciousness

clear consciousness moderate torpor deep torpor sopor moderate coma deep coma trance coma

Glasgow coma scale:


Consciousness level Opening the eyes: Voluntary In response to speech In response to pain Is absent Points 4 3 2 1

Glasgow coma scale:


Consciousness level Verbal response Well oriented Scrambled speech Incomprehensible words Inarticulate sounds No verbal response Points

5 4 3 2 1

Glasgow coma scale:


Consciousness level Points

Motor reactions Follows the instructions Purposeful reaction to pain Unpurposeful reaction to pain Tonic flexing reaction to pain Tonic extension reaction to pain No motor reaction

6 5 4 3 2 1

Glasgow coma scale:


a craniocerabral injury is considered severe when the consciousness impairment scores 3-8 points on the Glasgow scale if assessed in over 6 hours from the moment of injury with intensive therapy administered.

Intracranial hemorrhage

Epidural hemorrhage Subdural hematoma Intracerebral hematoma

epidural hemorrhage
three stages of consciousness

primary loss of consciousness regaining consciousness. This is called clear period; in epidural hemorrhage it is rather short upon progress of hemorrhage the patient loses consciousness again

on-the-spot treatment of craniocerebral injury

the ABC rule A is for airways B is for breathing C is for circulation

If there are no signs of tentorial herniation

the head raised by 30-45% prevention of hyperthermia sedatives and myotrelaxants administered to control agitation or cough reflex

If there are no signs of tentorial herniation

osmotic diuretics (mannitol) artificial hyperventilation (in case of artificial pulmonary ventilation) corticosteroids ventricular drainage (however, in he acute stage of craniocerebral injury lumbar puncture cannot be made) surgical treatment: craniotomy and removal of haematoma and cerebral detritus hypothermia barbiturates (thiopental)