Traumatology (accident medicine) is the science of wounds or injuries and their treatment.
What is traumatology?
Traumatology (accident medicine) is the science of wounds or injuries and their therapy. Traumatology deals with the treatment of minor and major injuries but also with the treatment of polytrauma. This refers to the occurrence of multiple injuries to different parts of the body, at least one of which is life-threatening. In addition, traumatology also plays a not insignificant role in bodily injury crimes in forensic medicine or even in occupational accidents.
Treatments and therapies
The word “trauma” comes from the Greek and means something like “injury” or “wound”. Here, the term refers to both the damaging effect (for example, an experience of shock or an accident) and the damage caused by the accident (for example, a flesh wound or a broken bone). Traumatology, therefore, deals with the occurrence, prevention, or treatment of injuries, but is limited only to physical injuries. Physicians who specialize in this field are therefore called orthopedic and trauma surgeons. Trauma physicians must provide first aid at the scene of an accident, and they are also responsible for shock treatment as well as surgical care. In such situations, rapid action is required: the physician must be able to assess whether the victim’s life is in danger, what needs to be done first, or where the injured person should be transported to. Patients who suffer from a so-called polytrauma, i.e. multiple injuries to different regions of the body, are particularly at risk. A polytrauma can be caused by a car accident, for example, which can lead to life-threatening complications. This requires a team with a great deal of experience, with doctors from several specialties predominantly working together here. High demands are also placed on the care of patients in the shock room, where there are usually fixed teams of at least three physicians. A shock room team is mainly used in the case of an unstable thorax, open cranial injuries, respiratory disorders, burns, amputation injuries or fractures of more than two bones. First of all, therefore, it is important to avert an acute threat, then the patients are subsequently cared for in the intensive care unit. This is often followed by further transfer to a special hospital, with rehabilitation over several weeks or months being necessary, especially in the case of multiple injuries. In addition, those affected also frequently need to be provided with aids or prostheses or require psychological support.
Diagnosis and examination methods
An examination therefore always covers the entire person or his or her sustained injuries and also includes any previous illnesses. In the case of people with minor injuries, the doctor limits himself to what is necessary for a diagnosis and appropriate therapy. At the scene of the accident, the first step is to check the patient’s level of consciousness, circulation and breathing, and the pelvis, extremities and spine are also examined. In the case of injuries to the extremities, blood circulation, sensitivity and motor function in particular are also checked. As an accompanying measure, a blood sample is also recommended for later laboratory tests, as well as tetanus prophylaxis. In severely injured patients, vital functions are secured and any surgical measures that may be required are performed in parallel, with vital functions being assessed according to the so-called ATLS protocol. The second to fourth day after the trauma is a very unstable phase in which no extensive operations should be performed. In order to be able to guarantee a comprehensive diagnosis or later rehabilitation, there is a wide range of imaging diagnostic procedures in the clinics. These include:
- Recto-proctoscopy: an endoscopic procedure used to examine the rectum (rectum). It is both a diagnostic and treatment procedure
- Rectosigmoidoscopy: An endoscopic procedure used to examine the rectum.
- Colonoscopy: computed tomography of the large intestine.
- Oesophago-gastroscopy: endoscopic examination of the duodenum, stomach, as well as the esophagus.
- Echocardiography: examination of the heart with the help of ultrasound.
- Sonography of soft tissues and joints
- Sonography of the thyroid gland, breast and abdomen
- Sonography of blood vessels
In addition, it is also possible to perform a skeletal scintigraphy (imaging nuclear medicine procedure to examine the skeleton), angiography (diagnostic imaging procedure to visualize blood vessels), phlebography (examination of the arm or leg veins using contrast agents) or MRI (magnetic resonance imaging). If the thorax is unstable, a spiral CT with contrast medium and a three-channel ECG are also performed in the shock room. If the injured suffer from a craniocerebral trauma, repeated documentation of motor function, pupillary function or consciousness is performed; unconscious patients are often intubated with adequate ventilation. In addition, it is necessary to exclude a life-threatening pelvic injury or to examine the stability of the pelvis. In this context, a computed tomography scan or a pelvic overview scan is often performed. External injuries or hematomas in the abdomen and flank are also searched for. In addition, the history of the spine is very important. If a spinal injury is present, it is clarified with the aid of an imaging procedure after stabilization of the circulation. Possible fractures are identified by appropriate radiological procedures, and basic diagnostics also include clinical evaluation of the hand. In this case, if a hand injury is suspected, an X-ray examination is performed for diagnosis. If a vascular injury is present, the physician in charge will perform duplex or Doppler ultrasonography.