This document summarizes the management of polytrauma, which involves injuries to multiple body regions. It discusses the assessment and treatment of injuries in a staged approach. The priorities are resuscitation of life threats, stabilization of injuries, and definitive treatment. Initial management involves assessing and stabilizing the airway, breathing, circulation, and disabilities like head injuries. Further treatment is then staged, with initial acute care, followed by primary stabilization within 3 days, then secondary stabilization from 3-8 days, and tertiary stabilization after 8 days involving reconstructive surgeries.

1. Management Of Polytrauma

2. Polytrauma ?
• Single patient with multiple injuries ?
• Multiple patients with multiple injuries ?

3. Poly = Multi Trauma
• Head Injury
• Chest Injury
• Abdominal Injury
• Skeletal Injury : Limb + Pelvis
• Spine Injury
• Urogenital Injury

4. Key Factors
• Team Approach
• Triage
• Damage control Orthopaedics
• Pre Hosp Care
• Primary Survery
• Secondary Survey

5. • Pre hospital care: EMT
• A & E : Resuscitation
• Specific management
• Nutritional support
• Rehabilitation

6. Assessment
• Primary Survey
• Airway
• Breathing
• Circulation
• Disability: Head Injury
• Estimate ISS

7. Prim Survey & Resus : Simultaneous
? Find the cause of haemodynamic/resp instability
- Quick short relevant history
- Mech of Injury
- Level of consciousness
- Any CPR instituted
- Restore Volume, Ventillation,
- Pharmacologic Support

8. Secondary Survey
• Head to toe evaluation
• History
• X rays: CXR, Pelvis, Cervical Spine

9. Mx Stages( Tscherne)
• Acute care: upto 3 hrs
• Primary Stabilization period : 1 hrs to 3 days
• Secondary Stabilisation 3 to 8 day
• Tertiary Stabilisation: > 8 days

10. Acute Care
• A,B,C, D
• Chest drain Vs thoracotomy > 1.5 L
• Laprotomy r/o pelvic injury
• External immobilization:
• Open fracure Mx
• Perineal wound ??? Colostomy
• C spine injury: Immobilize

11. Prim Stabilsation
• Adeq perfusion
• Steroid ??? Spinal injury
• Ix : MRI Vs CT
• Pelvic stabilisation : Ex Fix
• Limb stabilisation: Ex Fix Vs Nailing
• Compartment Release
• Open fracture Rx

12. • Second Look Debridement
• Flap Cover
• Closed Limb fracture :
LL> UL
Pelvis + LL
UL delayed

13. Secondary Stabilisation
• Intra articular resconstruction
• Complex spinal and limb fracrure treatment
• Definitive flaps

14. Teritiary Stabilization
• Amputation cover etc
• Reconstructive surgery

15. Damage control concept
• IL 6 > SIRS !!!!!!!
• Plan and stage Rx
• Evolved from abdominal injury studies
• Reduce the damage due to surgery
• Imp in Thoraic injury, ARDS, Long bone fracture

16. Airway
• Effort
• Excursion
• Effect
• Sounds
Obstruction : In Vs Out

17. Breathing
• Pneumothorax : Open, Tension , Flail
• Massive Haemothorax
• Asess ???
Should you wait for an X ray ???
When ICD ?

18. Circulation
• BP, HR , UO, Skin, Cyanosis
• Volume replace ??? How
• When blood ???
Thrombocytopaenia ???
Cardiac tamponade ?
Becks Triad : Venous High
Decrease Ar Pressure
Muffled HS

19. Head Injury
• GCS
• ISS
• Coma ?
• Neurogenic Shock Vs Hypovolaemic shock
• Spinal shock

20. Abdomen
• Clinical signs
• USG Vs CT Vs DPL
• Laprotomy

21. Spine
• Immobilise
• Asso injuries
• Steroids
• X ray : MRI : CT
• Disloc/ Fracture : Reduction

22. Pelvis
• See for
H hage
Stability
Dislocation
Hypothermia
Acidosis
Coagulopathy

23. Limb Injury
• Open Vs Closed
• LL Vs UL
• Pul injury Vs No lung injury
• Vascular injuries
• Compartments
• Stabilisation