Multiple Trauma – Trauma Shock

MULTIPLE TREATMENT

CONCEPT

• Currently, there is no complete definition of "multiple trauma".
• Multiple trauma is damage to multiple organs
• English multi-trauma is multiple injuries.
• Multiple Trauma has ICD 10 code T07. Listed by WHO as Injuries involving multiple body regions
• Multiple trauma is when two or more severe concurrent injuries are present and each has an impact on survival.

INJURY DEATH HAPPENS IN THREE STAGES

• Occurs immediately or within minutes of injury: laceration of the brain stem, rupture of the heart, aorta, or major arteries.
• Died from a few minutes to a few hours after injury: subdural or epidural hematoma, ruptured spleen, ruptured liver, etc. This is the golden time for doctors to save the victim's life. Therefore, advanced trauma life support (ATLS) has introduced the first aid regimen as: rapid assessment, active resuscitation and effective treatment.
• Death occurs days to weeks after injury. Death here resulted from adult acute respiratory distress syndrome (ARDS), multiple organ failure, and subsequent infectious complications.

Assessing the severity of the victim's severity is the first necessary thing to do in emergency resuscitation. It is also a necessary issue to evaluate the treatment results of doctors on multi-trauma victims.

PRICE SYSTEMS IN MULTIPLE TREATMENT

There are two evaluation systems applied, namely physiological evaluation system and anatomical evaluation system.

What is the tRTS (triage Revised Trauma Score) system?

The rRTS system is a review-selective multi-trauma quantitative index, also known as a rapid RTS index.

The tRTS scoring system is based on three main indicators:

• Glasgow coma scale score (GCS: Glasgow coma scale)
• Systolic blood pressure (SBP)
• respiratory rate (RR).

Table 2.1. Quantitative index of multiple trauma reviews – selective

tRTS = GCSc + SBPc + RRc

• When the tRTS score is 11 points, the patient has a very poor prognosis
• The tRTS scale is easy to calculate, so it is often used in the field and in clinical practice.

Revised Trauma Score (RTS)

The RTS score is an index of multiple trauma reviews.

Same tRTS score but with severe traumatic brain injury, mortality will be higher than internal bleeding. Then the tRTS score is incorrect. To overcome this situation, people add pre-calculated quantities to make the value of the scoring more accurate.

RTS = 0.9368 × GCSc + 0.7326 × SBPc + 0.2908 × RRc

However, this scale is a bit complicated, so it is less popular.

Injury Severity Score (ISS)

The ISS score is a measure of the severity of multiple trauma victims. This scale is rated according to each area of the body.

• The entire body is divided into six regions:

Respiratory and thoracic

Cardiovascular (based on pulse status and blood pressure)

+ Central nervous system

+ Abdomen and abdominal organs

+ The limbs and pelvis

Skin and subcutaneous tissue (burn and skin loss)

• Each damaged organ (area) is rated on the following scale:
  • 1 point: minor damage
  • 2 points: medium damage
  • 3 points: serious injury not life threatening
  • 4 points: severe injury is life-threatening, but still viable
  • 5 points: severe life-threatening injury, unlikely to live
  • 6 points: death from cardiovascular, central nervous system or severe burns died before hospital admission

– How to calculate ISS score

Select the three areas with the most severe damage (with the highest score). Each of those points is squared. The sum of those three squares gives an estimate of severity.

Thus we have:

+ Lightest: 3 points (1 + 1 + 1)

+ Heaviest: 75 points (25 + 25 + 25)

Many statistical samples show that with ISS score ≥ 16, the risk of death is 10%.

– Scoring on six body areas:

Thoracic – breathing

Heart

Central neutral system

Abdomen and abdominal organs

The limbs and pelvis

Skin and subcutaneous tissue

SHOCKET IN BROTHERS

Traumatic shock in fractures is the most common complication and has the potential to affect the victim's life if not diagnosed and treated promptly.

REASON

Two factors frequently encountered in fractures are the cause of traumatic shock:

• Blood loss: in an open fracture, blood flows out from the wound closed fracture Blood does not flow out but accumulates in the hematoma. This amount of blood no longer participates in circulation, so it is considered lost. This blood loss causes the loss of both red blood cells and plasma, reducing blood volume, so it will directly and quickly affect the circulatory system; right heart beats faster and systolic blood pressure drops.
• Pain: a broken bone that doesn't move is also painful, a broken bone that moves more is more painful if it doesn't work motionless and in rough handling of broken bones.

When determining a fracture, always consider whether traumatic shock is present.

PROSPECTS THE POSSIBILITY OF A BROTHER CAN BE Shocked

Based on the following two points:

• Severity of broken bones, including the following conditions:
  • Fracture of a large bone (fracture of the femur, broken pelvis)
  • Multiple bone fractures
  • Gãy xương có tổn thương mô mềm nhiều (gãy xương độ III)
  • The victim suffered multiple injuries.

These are risk factors to watch out for as they are more likely to cause shock.

• The following signs allow early detection of traumatic shock (due to blood loss):
  • Rapid pulse
  • Blood pressure drop
  • Shock index (CSC) > 1: CSC is the ratio of the number of pulse beats in 1 minute divided by the number of systolic blood pressure (in mmHg), this index is valid at each time point and is used to monitor the condition. patient's shock. According to a study by Allgoxver surveying the cases of shock due to acute blood loss due to trauma in adults, when the blood loss is 30%, this index = 1. The larger the index, the more severe the shock, the closer the indicators. with 1 should be wary, (shouldn't think that 0.99 is less than 1, it won't stun and 1.01 is greater than 1, it's stun).
    • Pulse/min Systolic blood pressure (mmHg)
    • Normal = 0.5; Stun 1
  • Signs of nail clipping: pink returns more than 2 seconds after stopping
  • Pale mucous membranes, pale skin, cold hands and feet, cold nose.

LOCATION

• It is the most common complication of fractures.
• Has an adverse effect on a number of other complications:
  • Fracture victims with severe trauma can easily cause complications of vascular occlusion due to fat.
  • The two fracture victims had the same condition cavity compression At the same time (same high pressure), people with traumatic shock have a worse prognosis than those without shock.
  • Victims open fracture In severe shock, the ability to fight infection is poor.

TREATMENT

• Treating shock as early as possible is more effective. Early prevention of shock is the best. (Therefore, prognostication of the possibility of early shock is important.)
• Treatment according to the general protocol of traumatic shock: fully compensate for blood and electrolytes, oxygen, ...
• Particularly for traumatic shock of fracture victims, attention should be paid to early treatment:
  • Stop bleeding with early immobilization of broken bones
  • Fight pain with:
    • Anesthesia for fractures: use novocaine solution 1 - 2% (If fracture is open, block the limb with a dilute novocaine solution 1/400 (= 0.25%)
    • Early immobilization of broken bones
• It is imperative not to transport the victim while in severe shock or at high risk of shock.

PREVENTIVE

Do it early (preferably right after the fracture):

• Anesthesia for fractures
• Good immobilization of the fracture area
• Do not transport the patient until the above two measures of shock prevention have been completed.

MULTI-TRAFFIC TEST – SHOCKET

See here

SLIDE LEARNING 

See here