Iyengar Karthikeyan P, Venkatesan Aakaash S, Jain Vijay K, Shashidhara Madapura K, Elbana Husam, Botchu Rajesh
Department of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK.
Department of Orthopaedics, University Hospital Sussex, Worthing, UK.
Orthop Res Rev. 2023 Mar 21;15:27-38. doi: 10.2147/ORR.S340532. eCollection 2023.
Polytrauma, a patient's condition with multiple injuries that involve multiple organs or systems, is the leading cause of mortality in young adults. Trauma-related injuries are a major public health concern due to their associated morbidity, high disability, associated death, and socioeconomic consequences. Management of polytrauma patients has evolved over the last few decades due to the development of trauma systems, improved pre-hospital assessment, transport and in-hospital care supported by complementary investigations. Recognising the mortality patterns in trauma has led to significant changes in the approach to managing these patients. A structured approach with application of advanced trauma life support (ATLS) algorithms and optimisation of care based on clinical and physiological parameters has led to the development of early appropriate care (EAC) guidelines to treat these patients, with subsequent improved outcomes in such patients. The journey of a polytrauma patient through the stages of pre-hospital care, emergency resuscitation, in-hospital stabilization and rehabilitation pathway can be associated with risks at any of these phases. We describe the various risks that can be anticipated during the management of polytrauma patients at different stages and provide clinical insights into early recognition and effective treatment of these to improve clinical outcomes.
多发伤是指患者出现涉及多个器官或系统的多处损伤,是导致青壮年死亡的主要原因。创伤相关损伤因其相关的发病率、高致残率、相关死亡以及社会经济后果,成为一个主要的公共卫生问题。在过去几十年中,由于创伤系统的发展、院前评估的改善、转运以及由辅助检查支持的院内护理,多发伤患者的管理方式不断演变。认识创伤的死亡模式已导致在管理这些患者的方法上发生了重大变化。采用先进创伤生命支持(ATLS)算法的结构化方法以及基于临床和生理参数的护理优化,促成了早期适当护理(EAC)指南的制定,以治疗这些患者,从而使此类患者的预后得到改善。多发伤患者从前院护理、紧急复苏、院内稳定到康复途径的整个过程,在这些阶段的任何一个阶段都可能存在风险。我们描述了在多发伤患者不同阶段的管理过程中可能预见的各种风险,并提供了关于早期识别和有效治疗这些风险以改善临床结果的临床见解。