Combined trauma includes a variety of diagnoses typical for people who survived after severe traumatic effects on numerous organs and areas of the body. Here, first of all, injuries are distinguished, in which, along with complex injuries of the head and internal organs, there are serious disorders in the area of the musculoskeletal system.
Main causes of combined injuries
Combined injury most often occurs due to serious accidents, falls from great heights or due to violent acts. According to disappointing statistics, the bulk of severe concomitant injuries occur on foot participants in road accidents. At the same time, the most frequent cases of death are observed when falling from a height.
If we talk about victims of violent acts, then such situations are characterized by serious craniocerebral and facial injuries along with injuries to the spine and internal organs.
Clinical picture
Combined trauma can be characterized by a wide variety of symptoms,which depend primarily on the localization of the most critical injuries, the presence of blood loss, traumatic shock conditions, disorders of the brain, disorders of the heart, respiratory system.
The overall clinical picture in case of combined injuries is determined on the basis of the leading damage, the presence of which hides a threat to life. However, it is not uncommon for there to be several lead injuries of equal severity.
Types of associated injuries
There is the simplest classification of complex combined polytraumas, which is most appropriate if it is necessary to determine the degree of damage by emergency physicians.
Based on the nature of the leading injury, combined injuries are classified as follows:
- open or closed injuries of the brain and skull in combination with injuries of the same nature to other areas of the body, such as the chest, celiac region, limbs, pelvis;
- open or closed injuries in the chest area, combined with craniocerebral injuries;
- open or closed injuries of the celiac cavity, head, spine, limbs;
- complex spinal injuries combined with injuries of other departments: brain, abdomen, pelvis, chest;
- serious damage to the pelvic area, combined with craniocerebral, celiac, chest injuries.
Multiple and associated trauma
Presence of multiple trauma in case ofthe presence of the victim's consciousness can lead to the formation of so-called pseudo-dominant lesions. This condition often causes the patient to focus on less severe injuries, distracting the physician from making a correct diagnosis.
To prevent a diagnostic error when receiving a multiple injury, an urgent manual and X-ray examination of the entire skeleton allows.
In the absence of consciousness when receiving multiple polytrauma, first of all, an examination is carried out for damage to the chest, spine, abdominal cavity, cranial and pelvic bones. At the same time, the presence of abrasions, edema, hematomas, limb mobility uncharacteristic for a stable state of limb mobility can become a reason for performing X-ray diagnostics of the limbs.
Emergency First Aid
Severe concomitant injury refers to injuries in which the stabilization of the victim's condition largely depends on the speed of first aid. To transport a patient in case of a combined injury, a rigid stretcher is required, which reduces the likelihood of blockage of the respiratory tract with blood, vomit, and also to avoid retraction of the tongue or lower jaw. In parallel, the nasopharyngeal area is cleaned with gauze wipes or medical suction of liquids. Severe concomitant injury may require opening the oral cavity with a special mouth expander.
Further, in case of lung failure, mouth-to-mouth artificial respiration is performed or with the help of the KI-ZM apparatus. With immediate, urgent, and most importantly, correct assistance, due to the implementation of the above measures, the victim recovers breathing, after which a conscious state usually sets in.
After the delivery of the victim to the combined trauma unit, the administration of polyglucin, prednisolone, hydrocortisone is required to stabilize the vital functions of the body. In the presence of severe injuries of the limbs with the occurrence of arterial bleeding, a tourniquet is applied.
Combined trauma in children or in a person in an extremely serious condition, in which there is low blood pressure, requires the administration of insulin, injections of 40% glucose into a vein without stopping the supply of polyglucin with hormones.
When a peripheral pulse occurs and pressure stabilizes at a level of up to 80 mm Hg. Art. in the case of combinations of limb fractures, it is not recommended to waste time on splinting. Instead, the focus is on preventing vital organ failure.
