Polytrauma

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Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury in addition to a serious burn. The term is defined via an Injury Severity Score (ISS) equal to, or greater than 16.[1] It has become a commonly applied term by US military physicians in describing the seriously injured soldiers returning from Operation Iraqi Freedom (Iraq) and Operation Enduring Freedom (Afghanistan). The term is generic, however, and has been in use for a long time for any case involving multiple traumata.

Civilian medicine[edit]

In civilian life, polytraumas often are associated with motor vehicle crashes. This is because car crashes often occur at high velocities, causing multiple injuries. On admission to hospital any trauma patient should immediately undergo x-ray diagnosis of their cervical spine, chest, and pelvis, commonly known as a 'trauma series', to ascertain possible life-threatening injuries. Examples would be a fractured cervical vertebra, a severely fractured pelvis, or a haemothorax. Once this initial survey is complete, x-rays may be taken of the limbs to assess the possibility of other fractures. It also is quite common in severe trauma for patients to be sent directly to CT or a surgery theatre, if they require emergency treatment.

Extracorporeal membrane oxygenation (ECMO) may be effective in treating some polytrauma patients with pulmonary or cardiopulmonary failure.[2]

Military medicine[edit]

Polytrauma often results from blast injuries sustained from improvised explosive devices, or by a hit with a rocket-propelled grenade, with "Improvised explosive devices, blasts, landmines, and fragments account[ing] for 65 percent of combat injuries...".[3] The combination of high-pressure waves, explosive fragments, and falling debris may produce multiple injuries including brain injury, loss of limbs, burns, fractures, blindness, and hearing loss,[4] with 60 percent of those injured in this way, having some degree of traumatic brain injury.[3]

In some respects, the high incidence of polytrauma in military medicine is, in fact, a sign of medical advancement, for in previous wars soldiers with such multiple injuries, in most cases, simply did not survive, even if quickly transferred into hospital care. Unfortunately, now many of these victims, although surviving, never will fully regain their previous physical and/or mental form (i.e. they'll be more susceptible to psychological complications, such as PTSD).[3]

U.S. treatment[edit]

One of the U.S. clinics specialising in polytrauma, this one in Palo Alto

As of 2013, there were five rehabilitation centers in the U.S. specialising in polytrauma. They are managed by the United States Department of Veterans Affairs and are located in Minneapolis, Minnesota; Palo Alto, California; Richmond, Virginia; San Antonio, Texas, and Tampa, Florida.[4] In addition to the intensive care, insofar as still required, these hospitals mainly specialize in rehabilitative treatment. In addition the department of Veterans Affairs has 22 polytrauma network sites, located throughout the country. As of April 2007, the department of Veterans Affairs has treated more than 350 service members in their inpatient centers.

The treatment and rehabilitative care for polytrauma patients is a very extensive and time-consuming activity. The recommended staffing numbers (FTE = Full Time Equivalent) for six rehabilitation treatment beds are:[3]

In other words, 2.8 people are required full-time (24h), for every patient, often for months, while some care may be required for life.

References[edit]

  1. ^ Pathophysiology of polytrauma - Keel, M. & Trentz O. - Injury, Volume 36, Issue 6, Pages 691-709
  2. ^ http://www.resuscitationjournal.com/article/S0300-9572%2810%2900124-3/abstract Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock
  3. ^ a b c d Polytrauma Rehabilitation Procedures - Veterans Health Administration (VHA) Handbook, Thursday September 22, 2005
  4. ^ a b President's Project: Support for VAMC Polytrauma Centers (from the American Legion Auxiliary website)