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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 injury is a trauma of the head. This can or cannot incriminate injury to the brain. In addition, the terms traumatic brain injury and head injury are often used interchangeably in medical literature.
The incidence 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 America and 9 per 100,000 in 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 scalp and skull. Head injuries may be closed or open. A closed or non-missile head injury is where the durameter remains intact. The skull can be fractured, but not necessarily. A 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 headache skull fracture which can or cannot be associated with injury to the brain. Some patients may have linear or depressed skull fractures.
If intracranial hemorphage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subdural, subarachnoid, extradural and intraparenchymal hematomas. Craniotomy 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 a contrecoup 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:
Lacerations to the scalp and resulting 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 a coma or death
Shaken Baby Syndrome - 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 without 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 include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headaches and lucid interval, during which a patient appears conscious only to deteriorate later.
Symptoms of skull fracture can include:
Leaking cerebrospinal fluid which a clear fluid drainage from nose, mouth and ear may be and is strongly indicative of basilar skull fracture and the tearing of sheaths surrounding the brain, which can lead to secondary brain infection.
Visible deformity or depression in the head or face; for example a sunken eye can indicate a maxilla fracture
An eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerve that innervates eye muscles.
Wounds or bruises on the scalp or face.
Basilar skull fractures, those that occur at the base of the skull, are associated with Battle's sign, a subcutaneous bleed over the mastoid, hemotympanum, and 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.
The Gaslow Coma Scales is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Gaslow Coma Scale is used in young children.
CHEST TRAUMA :
Chest trauma or thoracic trauma is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. The mortality rate is about 10%. Chest injuries were first described in detail in around 1600 BC in the ancient Egyptian Edwin Smith Papyrus.
Chest trauma can be classified as blunt or penetrating. Blunt and penetrating injuries have different pathophysiologies and clinical courses.
Specific types of chest trauma include:
Injuries to the chest wall
Chest wall contusions or hematoma.
Fractures of the shoulder griddles
Pulmonary injury (injury to the lung) and injuries involving the 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 like tracheal intubation and mechanical ventilation and chest tube insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning. Penetrating injuries often require 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 trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms includeabdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Injury to the lower chest may cause splenic or liver injuries.
Abdominal trauma is divided into blunt and penetrating types. While penetrating abdominal trauma (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. Blunt injuries predominate in rural areas, while penetrating ones are more frequent in urban settings. Penetrating trauma is further subdivided into stab wounds and gunshot wounds, which require different methods of treatment.
SIGN AND SYMPTOMS
People injured in motor vehicle collisions may present with a "seat belt 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. Seatbelts may also cause abrasions and hematomas; up to 30 percent of people with such signs have associated internal injuries. Early indications of abdominal trauma include nausea, vomiting, and fever. Blood in the urine is another sign. The injury may present with abdominal pain, tenderness, distension, or rigidity to the touch, and bowel sounds may be diminished or absent. Abdominal guarding is a tensing of the abdominal wall muscles to guard inflamed organs within the abdomen. Pneumoperitoneum, air or gas in the abdominal cavity, may be an indication of rupture of a hollow organ. In penetrating injuries, an evisceration (protrusion of internal organs out of a wound) may be present.
Injuries associated with intra-abdominal trauma include rib fractures, vertebral fractures, pelvic fractures, and injuries to the 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 the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood. Solid abdominal organs, such as the liver and kidneys, bleed profusely when cut or torn, as do major blood vessels such as the aorta and vena cava. Hollow organs such as the stomach, while not as likely to result in shock from profuse bleeding, present a serious risk of infection, especially if such an injury is not treated promptly. Gastrointestinal organs such as the bowel can spill their contents into the abdominal cavity. Hemorrhage 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.
A limb is a word from the Old English lim which is a joint, or prehensile where as octopus tentacles or new world monkey tails, appendage of the human or other animal body.
Most animals use limbs for locomotion, such as walking, running, or 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 the human body, the upper and lower limbs are commonly called the arms and the legs. Human legs and feet are specialised for two-legged locomotion - most other mammals walk and run 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 specialised hands 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. Most cases of blunt trauma are caused by motor vehicle accidents. Falls, a subset of blunt trauma, are the second most common cause of traumatic death. In most cases a fall of greater than three times the victim's height is defined as a severe fall. Penetrating trauma is caused when a foreign object such as a bullet or a knife enters a tissue of the body, creating an open wound. In the United States most deaths caused by penetrating trauma occur in urban areas and 80% of these deaths are caused by fierarms. Blast injury is a complex cause of polytrauma. It commonly includes both blunt and penetrating trauma and may also be accompanied by a burn 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 of alcohol and illicit drugs are risk factors for trauma, particularly traffic collisions, violence and abuse. Long-acting benzodiazepines increase the risk of trauma in elderly 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 a 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-rays of the chest and pelvis are commonly performed in major trauma. Focused assessment with sonography for trauma (FAST), can also be used.Computed tomography (CT) scans are the gold standard in imaging in major trauma. They however may only be performed in people with a relatively stable blood pressure, heart rate, and sufficient oxygenation. Full-body CT scans known as pan-scans improve survival in those who have suffered major trauma. The scans are done using intravenous radiocontrast but not oral contrast. There are concerns of radiation exposure and concerns regarding negative effects of contrast on the kidneys. However some centers routinely do CTs with contrast before verifying renal function even in the elderly and have not found negative side effects with respect to the kidneys. 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 significantly hemodynatically unstable from presumed abdominal bleeding delaying surgery for abdominal CT imaging may worsen outcomes.
Surgical techniques, such as diagnosis peritoneal lavage, placement of a thoracostomy tube, or pericardiocentesis 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 are hypotensive due to presumed internal abdominal bleeding transfer to the operating room for a laporotomy is the preferred method of determining a definitive diagnosis.