Polytrauma means multiple injuries. By definition, these are serious, life-threatening injuries. There is a risk of cardiovascular failure due to shock or craniocerebral injury in polytrauma.
What is polytrauma?
Polytrauma (plural: polytraumas) is a term used in emergency medicine. The translation of the Greek compound word is “multiple injury.” This always refers to a severe injury, consisting of at least 2 injuries to a patient either:
- To at least 2 regions of the body or
- Different types of injuries to one or more body regions.
By definition, a polytrauma is a condition with acute danger to life. In this case, the threat to life can come from only one or several injuries at the same time. Characteristic is further a volume deficiency shock caused by external or internal bleeding. Scaled calculation systems are available for assessing and classifying the severity of polytrauma. For example, the Injury Severity Score (GCS) serves as one of the most common scale systems for classification in polytrauma.
Causes
Polytrauma is the result of exposure to violence. In the most common case, the severe injuries occur in the context of traffic accidents, but work accidents also cause polytrauma not infrequently. Furthermore, it is violent crimes or suicide attempts such as window falls that are causally responsible for multiple injuries. In the context of accidents, acute illnesses also play a role, which are possible triggers but are often misjudged. For example, a traffic accident may be caused by a stroke, which initially remains undetected because the symptoms of the polytrauma are superimposed on the syndrome of apoplexy. This is often aggravated by intoxication with alcohol or drugs, which also causes the accident. About 1% of all emergency patients with injuries suffer from polytrauma.
Symptoms, complaints, and signs
Polytrauma can have many different symptoms. All of these symptoms equate to injuries, at least two of which must exist to define polytrauma. Furthermore, polytrauma usually also means that the victim is in a state of shock. In most cases, unconsciousness occurs. Typical symptoms in polytrauma include circulatory shock, severe traumatic brain injury, or spinal injury. These conditions are among the most severe in such a trauma. Furthermore, rib fractures, injuries to the extremities, internal bleeding, failure of individual organs or the occurrence of large wounds may also occur. Furthermore, injuries are further classified. For example, gunshot wounds or very severe contusions are also possible symptoms of polytrauma. In most cases, there is severe blood loss. The more injuries that occur, the more severe the trauma. Accordingly, the survival rate also decreases with the severity and complexity of the injuries. The first days after the occurrence of the trauma also carry an increased risk for the occurrence of renal failure or fat embolism. In most cases, polytrauma means complete incapacitation for those affected. Some affected individuals also fall into a coma as a result of such trauma.
Diagnosis and course
A polytrauma is often already recognizable by the rescue service on the basis of the finding situation and also on the condition of the patient. Diagnostically, the focus is now on checking vital signs. Blood pressure, ECG and respiratory activity are important factors in determining whether the casualty is fit for transport. The emergency physician must also select the means of transport and, in severe cases, request a helicopter. It is only in the hospital that the individual injuries can be precisely determined. An ultrasound examination provides the initial findings on injuries to the internal organs, including the chest cavity. In addition, a whole-body computed tomography scan is performed today. The classic X-ray can also contribute to the diagnosis, but often cannot be made depending on the condition of the patient with polytrauma.
Complications
Polytrauma, by definition, is a condition in which the patient has suffered multiple serious injuries simultaneously, at least one of which is life-threatening. The specific complications that may arise depend on the nature of the injuries and how the accident occurred.Patients who have suffered fractures in both arms and legs at the same time are largely immobile for months and require one hundred percent care. If the affected person is conscious, he or she suffers from enormous physical pain that cannot always be completely suppressed even with medication. For many of those affected, the complete helplessness that arises, especially when both arms are broken, is accompanied by a great psychological burden. The nursing measures, especially during intimate procedures, are often perceived as humiliating. If an injury to the spinal column in conjunction with paralysis of the extremities is added, the patients usually feel no pain or significantly less pain because the nerve connection to the brain is interrupted. The possibility of permanent paralysis or even complete loss of the ability to move the limbs places an enormous psychological burden on those affected. Even with injuries that are not quite so severe, sufferers face months of convalescence, with permanent damage very likely.
When should you see a doctor?
If irregularities or changes in health are evident due to an external effect on the affected person’s body, a doctor should be consulted to clarify the symptoms. In acute situations, an ambulance is needed to provide first aid. Those present are encouraged to provide immediate care and first aid until the arrival of the emergency physician. Loss of consciousness, impaired orientation, or abnormality of memory function should be investigated and treated. Headaches, severe blood loss, and pain in the body must be sought medical attention. If deformities of the body occur, the musculoskeletal system is restricted or open wounds are evident, the affected person needs help. In the case of blunt injuries, a violent blow to the head, and severe nausea with vomiting, a visit to the doctor is required. Most often, polytrauma occurs after a severe fall, an accident, or exposure to violence. A physician should be consulted so that the injuries are documented and treated. Bruising, wounding of limbs, and a hunched posture indicate irregularities that should be presented to a physician. If internal bleeding occurs, breathing is blocked, or shock is evident, immediate assistance is needed. Sudden discoloration of the skin appearance, internal weakness, and misalignment of the bones are signs of illness and require medical attention.
Treatment and therapy
In polytrauma, the first responder plays an important role. He usually not only alerts the rescue service, but should also perform acute life-saving measures. These immediate interventions are:
- The stable side position in case of unconsciousness,
- The cardiopulmonary resuscitation in cardiac arrest by mouth-to-mouth.
or mouth-to-nose resuscitation and cardiac massage as well as
- Hemostasis of external injuries by temporary wound closure.
Resuscitation continues the rescue team with apparative methods. The goal is to stabilize the patient, who must be placed in a transportable condition. To combat volume deficiency shock, infusions are administered, which are supplemented by blood transfusions in the hospital. The first thing the trauma surgeon will do now is to surgically stop the bleeding. In the course of treatment, priority is always given to the injury that is acutely life-threatening, so the focus is specifically on the condition of the internal organs. Urgent is also the treatment of a craniocerebral trauma as well as fractures of the spine and the large bones. This is because fractures of the pelvis or femur can lead to life-threatening blood loss. Minor injuries to the skeletal apparatus are initially treated only provisionally. The general principle is “treat first what kills first”. As a rule, treatment in the shock room and operating room is followed by intensive medical monitoring with airway management. This is because patients often lie in a coma, caused by polytrauma.
Prevention
Polytrauma and prevention is an accident prevention issue. Safety rules in the workplace, professional protective clothing and attention to self-protection should never be lost sight of.Since most polytraumas are caused by traffic accidents, this is also where the greatest potential for prophylaxis lies. Many accidents on the road result from non-compliance with the simplest rules from driving school. Those who observe them make a contribution to the prevention of polytrauma.
Aftercare
Aftercare for polytrauma can vary widely. Depending on what injuries were present, either no aftercare at all may be required or extensive measures may need to be taken. Treatment for broken bones involves immobilizing the affected joints, which causes unused muscles to break down significantly. Physiotherapy ensures that the joints are mobilized again and that targeted muscle development takes place. If certain functions of the body could not be restored despite treatment, follow-up care aims to ensure that the patient has as high a quality of life as possible despite his or her limitations. If, for example, disabilities have arisen as a result of amputations, training in the use of a prosthesis is part of aftercare. If affected organs can no longer function or can no longer function to their full extent, close follow-up care is required. Training the patient helps him or her to cope better with the limitations. In this way, those affected after a polytrauma can cope better with the new situation and remain as independent as possible. A polytrauma often also has psychological consequences. These are not always recognized immediately and should also be given attention in good aftercare.
What you can do yourself
Anyone who has survived a polytrauma may remain “traumatized” for quite some time afterwards. Often years pass until the sometimes life-threatening injuries are healed. Medically, everything necessary may have been done for the patient – but what about his or her psyche? Hospitals that belong to the TraumaNetwork offer special consultation hours for polytraumatized patients. Here, those affected can find contact persons and psychologists who can provide assistance in coping with this life crisis over and above the medical issues. It is also advisable to join a self-help group. They exist in all larger cities. Those who live in rural areas and are unable to regularly attend a group far away should definitely seek psychological support. In addition, it is important to maintain friendships and not withdraw. The feeling of having been severely injured and helpless can be frightening beyond the actual injuries. Here it is important to actively counteract the fear and to do as many things as possible that are good for the soul. This can be a wellness vacation as well as a long, extended bath.
