Marsden Nicholas J., Tuma Faiz
Central Michigan University
The term "polytrauma" is used frequently in trauma practice and literature. It refers to multiple injuries that involve multiple organs or systems. This condition is in contrast to isolated trauma injury where there is a single injury encountered. The evaluation, management, and prognosis of polytraumas are significantly different from isolated injuries. Polytrauma has a significant impact on the wellbeing and provided healthcare for the populations. Millions of patients seek medical help as a result of trauma, with a substantial proportion of patients suffering from life-changing or life-limiting injuries. The leading cause of traumatic death worldwide is road traffic collision, followed by suicide and homicide. Identifying the mortality patterns in trauma has been the driving force behind establishing trauma networks and major trauma centers in an attempt to improve management in the initial stages of traumatic injury. Professor Richard Cowley coined the phrase ‘The Golden Hour' following his observations in Baltimore, U.S.A., and the U.S. Army during the Second World War, where he concluded that the vast majority of deaths occurred in the first 60 minutes following injury. Further research in the trauma deaths has resulted in the description of trauma deaths with a trimodal distribution. This model describes deaths following traumatic injury in three peaks; immediate, early, and late. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury, usually as a result of traumatic brain injury or major exsanguination. The late deaths occur within days or weeks of the initial injury and are generally secondary to multiorgan failure or sepsis. Due to the high mortality and morbidity of trauma, medical professionals need to adopt the principles of an organized approach to the initial management of their patients. Management protocols are designed to help medical teams treating trauma patients with decision making and treatment promptly systematic approach, so that outcomes for patients may be improved. The primary survey follows the ABCDE system that includes assessment and management of irway, reathing, irculation, isability, and xposure.
“多发伤”一词在创伤实践和文献中经常被使用。它指的是涉及多个器官或系统的多处损伤。这种情况与单一创伤损伤形成对比，单一创伤损伤是指仅遇到一处损伤。多发伤的评估、处理和预后与单一损伤有显著不同。多发伤对人群的健康和所提供的医疗保健有重大影响。数以百万计的患者因创伤寻求医疗帮助，其中很大一部分患者遭受了改变生活或危及生命的损伤。全球创伤死亡的主要原因是道路交通碰撞，其次是自杀和杀人。确定创伤中的死亡模式一直是建立创伤网络和重大创伤中心的驱动力，目的是改善创伤性损伤初始阶段的处理。理查德·考利教授在美国巴尔的摩以及第二次世界大战期间在美国陆军的观察之后创造了“黄金一小时”这个短语，他得出的结论是，绝大多数死亡发生在受伤后的头60分钟内。对创伤死亡的进一步研究导致了对具有三峰分布的创伤死亡的描述。这个模型描述了创伤性损伤后死亡的三个高峰：即刻、早期和晚期。即刻和早期死亡占受伤后头几个小时内发生的创伤死亡的近80%，通常是由于创伤性脑损伤或大量失血。晚期死亡发生在初始损伤后的数天或数周内，通常继发于多器官功能衰竭或脓毒症。由于创伤的高死亡率和高发病率，医疗专业人员需要采用有组织的方法对其患者进行初始处理。管理方案旨在帮助治疗创伤患者的医疗团队以迅速、系统的方法进行决策和治疗，从而改善患者的预后。初级评估遵循ABCDE系统，包括气道、呼吸、循环、残疾和暴露的评估和处理。
