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Trauma is a body wound or shock that occurred by sudden physical injury such as violence or accident. Because of that, it is shown as 'physical wound or accident like fracture or stomp'. Besides that, Trauma major which can measured by 'Injury Severity Score of greater than 15' is can caused a second complication like blood circularly shock, breath failure and death. Other than that, resuscitation of a trauma patient always involving the multiple management procedure. Furthermore, trauma is one of the main factor of the deaths of the sixth world, accounting for the 10% from all of the death and a public health problem which is serious with the social and economy significant.
Sometimes, polytrauma is called multiple trauma. They are in medical term which are describing the person's condition who are been subjected to multiple traumatic injuries or polytraumatic. For example, serious head injury which is in addition to a serious bum. We can measured it via Injury Severity Score (ISS) which greater than seventeen. Besides that, the term has been used for a long time ago for any case which incriminate multiple trauma or polytrauma and it is general.
CIVILIAN MEDICINE :
Polytrauma or multiple trauma in civilian life are usually occur because of motor vehicle accidents. In addition, the motor vehicle accident always happened in high speeds or high velocities which are causing the multiple injuries. Because of that, on the admission to the hospital for any trauma case of patient should be quickly arranged for the imaging diagnostic for the cervical spine, the pelvis, the chest and the extremities which are generally known as a 'trauma series'. Besides that, it is because to confirm for any possibilities of the life threatening damage. For example, it maybe fractured on cervical vertebra or thoracic vertebra or lumbar vertebra or severely cracked on pelvis or a heamothorax. Moreover, diagnostic imaging can be taken to assess for another possible fractures when complete of the initial survey. Furthermore, severe trauma patient also quite generally to go for the CT scan or the surgery theatre if they are required to do the emergency treatment. Other than that, extracorporeal membrane oxygenation (ECMO) for polytrauma patients or multiple trauma patients can be effective treatment for the cardiopulmonary or pulmonary failure.
Head injury :
Head injuryÂ is aÂ traumaÂ of theÂ head. This can or cannot incriminate injury to theÂ brain. In addition, the termsÂ traumatic brain injuryÂ andÂ head injuryÂ are often used interchangeably in medical literature.
TheÂ incidenceÂ which is number of new cases of head injury is 300 of every 100,000 per year 0.3% of the population, with a mortality rate of 25 per 100,000 in North AmericaÂ and 9 per 100,000 inÂ Britain. Head trauma is a common cause of childhood hospitalization
Head injuries include both injuries to the brain and those to other parts of the head, such as the scalpÂ and skull. Head injuries may be closed or open. A closed or non-missile head injury is where the durameterÂ remains intact. The skull can be fractured, but not necessarily. AÂ penetrating head injury occurs when an object pierces the skull and breaches the duramater. Brain injuries may be diffuse because of the occurring over a wide area, or focal, located in a small, specific area.
A head injury may cause a minor headacheÂ skull fracture which can or cannot be associated with injury to the brain. Some patients may have linear or depressed skull fractures.
IfÂ intracranial hemorphageÂ occurs, aÂ hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subdural, subarachnoid, extradural and intraparenchymal hematomas. CraniotomyÂ surgeries are used in these cases to lessen the pressure by draining off blood. Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to aÂ contrecoupÂ effect which is the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact.
If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull both are contrecoup injuries.
Specific problems after head injury can include:
LacerationsÂ to the scalp and resultingÂ hemorrahage of the skin
Traumatic subdural hematoma, a bleeding below the durameter which may develop slowly
Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull
Traumatic subarachnoid hemorrhage
Cerebral contuision a bruise of the brain
Concussion a temporary loss of function due to trauma
Dementia pugilistica or "punch-drunk syndrome", caused by repetitive head injuries, for example in boxing or other contact sports
A severe injury may lead to aÂ coma or death
Shaken Baby SyndromeÂ - a form of child abuse
Signs and symptoms
Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or withoutÂ neurologic deficit. Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur. Common symptoms of head injury includeÂ coma, confusion, drowsiness, personality change,Â seizures, nausea and vomiting, headaches and lucid interval, during which a patient appears conscious only to deteriorate later.
Symptoms of skull fracture can include:
LeakingÂ cerebrospinal fluidÂ which a clear fluid drainage fromÂ nose, mouth and ear may be and is strongly indicative ofÂ basilar skull fractureÂ and the tearing of sheaths surrounding the brain, which can lead to secondary brainÂ infection.
Visible deformity or depression in the head or face; for example a sunken eye can indicate a maxillaÂ fracture
An eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerveÂ that innervates eye muscles.
Wounds or bruises on the scalp or face.
Basilar skull fractures, those that occur at the base of theÂ skull, are associated withÂ Battle's sign, aÂ subcutaneousÂ bleed over theÂ mastoid,Â hemotympanum, andÂ cerebrospinal fluid rhinorrhea and otorrhea.
Because brain injuries can be life threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation. The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.
TheÂ Gaslow Coma Scales is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. TheÂ Pediatric Gaslow Coma ScaleÂ is used in young children.
CHEST TRAUMA :
Chest traumaÂ orÂ thoracic trauma is a serious injury of theÂ chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death fromÂ physical traumaÂ after head and spinal cord injury.Â Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths.Â TheÂ mortality rateÂ is about 10%.Â Chest injuries were first described in detail in around 1600 BC in the ancient EgyptianÂ Edwin Smith Papyrus.
Chest trauma can be classified asÂ bluntÂ orÂ penetrating. Blunt and penetrating injuries have differentÂ pathophysiologiesÂ and clinical courses.
Specific types of chest trauma include:
Injuries to theÂ chest wall
Chest wallÂ contusionsÂ orÂ hematoma.
Fractures of theÂ shoulder griddles
Pulmonary injury (injury to the lung) and injuries involving theÂ pleural space
Injury to the airways
Blood vessel injuries
Traumatic aortic rupture, thoracic aorta injury
And injuries to other structures within the torso
Esophageal injury (Boerhaave syndrome)
Most blunt injuries are managed with relatively simple interventions likeÂ tracheal intubationÂ andÂ mechanical ventilationÂ andÂ chest tubeÂ insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such asÂ CT scanning. Penetrating injuries often requireÂ surgery, and complex investigations are usually not needed to come to a diagnosis. Patients with penetrating trauma may deteriorate rapidly, but may also recover much faster than patients with blunt injury.
ABDOMINAL TRAUMA :
Abdominal traumaÂ is an injury to theÂ abdomen. It may beÂ bluntÂ orÂ penetratingÂ and may involve damage to the abdominalÂ organs. Signs and symptoms includeabdominal pain, tenderness, rigidity, andÂ bruisingÂ of the external abdomen. Abdominal trauma presents a risk of severeÂ blood lossÂ andÂ infection. Diagnosis may involveÂ ultrasonography,Â computed tomography, andÂ peritoneal lavage, and treatment may involve surgery.Â Injury to the lowerÂ chestÂ may cause splenic or liver injuries.
Abdominal trauma is divided into blunt and penetrating types. WhileÂ penetrating abdominal traumaÂ (PAT) is usually diagnosed based on clinical signs, diagnosis of blunt abdominal trauma is more likely to be delayed or altogether missed because clinical signs are less obvious.Â Blunt injuries predominate in rural areas, while penetrating ones are more frequent in urban settings.Â Penetrating trauma is further subdivided intoÂ stab woundsÂ andÂ gunshot wounds, which require different methods of treatment.
SIGN AND SYMPTOMS
People injured inÂ motor vehicle collisionsÂ may present with a "seat beltÂ sign," bruising on the abdomen along the site of the lap portion of the safety belt; this sign is associated with a high rate of injury to the abdominal organs.Â Seatbelts may also cause abrasions and hematomas; up to 30 percent of people with such signs have associated internal injuries.Â Early indications of abdominal trauma includeÂ nausea,Â vomiting, andÂ fever.Â Blood in the urineÂ is another sign.Â The injury may present withÂ abdominal pain,Â tenderness,Â distension, or rigidity to the touch, andÂ bowel soundsÂ may be diminished or absent. Abdominal guardingÂ is a tensing of theÂ abdominal wall musclesÂ to guard inflamed organs within the abdomen.Â Pneumoperitoneum, air or gas in theÂ abdominal cavity, may be an indication of rupture of a hollow organ. In penetrating injuries, anÂ eviscerationÂ (protrusion of internal organs out of a wound) may be present.
Injuries associated with intra-abdominal trauma includeÂ rib fractures,Â vertebral fractures, pelvic fractures, and injuries to theÂ abdominal wall.
Presentation Cause Haemorrage. Liver / spleen rupture Hematuria. Kidney, bladder, ureter injury Back pain. Injury to retroperitoneum Peritonitis. Injury hollow viscus Respiratory. Pneumothorax
Abdominal trauma can be life threatening because abdominal organs, especially those in theÂ retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood.Â Solid abdominal organs, such as theÂ liverÂ andÂ kidneys, bleed profusely when cut or torn, as do major blood vessels such as theÂ aortaÂ andÂ vena cava.Â Hollow organs such as theÂ stomach, while not as likely to result in shock from profuse bleeding, present a serious risk of infection,Â especially if such an injury is not treated promptly.Â Gastrointestinal organs such as the bowel can spill their contents into the abdominal cavity.Â HemorrhageÂ and systemic infection are the main causes of deaths that result from abdominal trauma.
One or more of the intra-abdominal organs may be injured in abdominal trauma. The characteristics of the injury are determined in part by which organ or organs are injured.
AÂ limbÂ is a word from the Old EnglishÂ lim which is a joint, orÂ prehensileÂ where asÂ octopusÂ tentacles or new worldÂ monkeyÂ tails,Â appendageÂ of theÂ humanÂ or other animalÂ body.
Most animals use limbs forÂ locomotion, such asÂ walking,Â running, orÂ climbing. Some animals can use their front limbs (or upper limbs in humans) to carry and manipulate objects. Some animals can also use hind limbs for manipulation.
In theÂ humanÂ body, theÂ upperÂ andÂ lower limbsÂ are commonly called theÂ armsÂ and theÂ legs. Human legs andÂ feetÂ are specialised for two-legged locomotion - most other mammalsÂ walkÂ andÂ runÂ on all four limbs. Human arms are weaker, but very mobile allowing us to reach at a wide range of distances and angles, and end in specialisedÂ handsÂ capable of grasping and fine manipulation of objects
CAUSES AND RISK FACTORS:
Blunt trauma is the leading cause of traumatic death in the United States.Â Most cases of blunt trauma are caused byÂ motor vehicle accidents.Â Falls, a subset of blunt trauma, are the second most common cause of traumatic death.Â In most cases a fall of greater than three times the victim's height is defined as a severe fall.Â Penetrating trauma is caused when aÂ foreign objectÂ such as a bullet or a knife enters aÂ tissueÂ of the body, creating an openÂ wound. In the United States most deaths caused by penetrating trauma occur inÂ urban areasÂ and 80% of these deaths are caused byÂ fierarms. Blast injuryÂ is a complex cause of polytrauma. It commonly includes both blunt and penetrating trauma and may also be accompanied by aÂ burnÂ injury.
By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems can help to enhance the overall health of its population. Ingestion ofÂ alcoholÂ andÂ illicit drugsÂ are risk factors for trauma, particularly traffic collisions,Â violenceÂ andÂ abuse.Â Long-actingÂ benzodiazepinesÂ increase the risk of trauma inÂ elderlyÂ people.
The purpose of the primary survey is to identify life-threatening problems. Upon completion of the primary survey, the secondary survey is begun. This may occur during transport or upon arrival at the hospital. The secondary survey consists of a systematic assessment of the abdominal, pelvic and thoracic area, complete inspection of the body surface to find all injuries, and aÂ neurological examination. The purpose of the secondary survey is to identify all injuries so that they may be treated. A missed injury is one which is not found during the initial assessment (for example, as a patient is brought into a hospital's emergency department), but rather manifests itself at a later point in time.
X-raysÂ of theÂ chestÂ andÂ pelvisÂ are commonly performed in major trauma.Â Focused assessment with sonography for traumaÂ (FAST), can also be used.Computed tomographyÂ (CT) scans are the gold standard in imaging in major trauma.Â They however may only be performed in people with a relatively stable blood pressure,Â heart rate, andÂ sufficient oxygenation.Â Full-body CT scansÂ known as pan-scans improve survival in those who have suffered major trauma.Â The scans are done using intravenousÂ radiocontrastÂ but not oral contrast.Â There are concerns ofÂ radiationÂ exposure and concerns regarding negative effects of contrast on theÂ kidneys. However some centers routinely do CTs with contrast before verifyingÂ renal functionÂ even in the elderly and have not found negative side effects with respect to the kidneys.Â With modern imaging technology a complete scan can be performed in less than 10 minutes. In the emergency department in the United States CT or MRI imaging is done in 15% of people who present with injuries as of 2007 (up from 6% in 1998). In those who are significantlyÂ hemodynaticallyÂ unstable from presumed abdominal bleeding delaying surgery for abdominal CT imaging may worsen outcomes.
Surgical techniques, such asÂ diagnosis peritoneal lavage, placement of aÂ thoracostomy tube, orÂ pericardiocentesisÂ are often used in cases of severe blunt trauma to the chest or abdomen, especially in the setting of deteriorating hemodynamic stability. In those who areÂ hypotensiveÂ due to presumed internal abdominal bleeding transfer to theÂ operating roomÂ for aÂ laporotomyÂ is the preferred method of determining a definitive diagnosis.