Multiple Trauma & Multisystem Trauma Notes

Multiple Trauma vs. Multisystem Trauma

  • Multiple trauma: More than one serious injury.

  • Multisystem trauma: One or more injuries severe enough to affect multiple body systems.

Initial Management

  • Primary assessment is crucial to reveal life-threatening injuries.

  • Address life-threatening injuries (airway obstruction, severe bleeding) before non-life-threatening ones (e.g., splinting an arm).

  • Prioritize actions that provide the most benefit and reduce risk.

Teamwork, Timing, and Transport

  • Teamwork is critical for efficient patient care.

  • Rapid transport to definitive care (hospital) is essential.

  • The appropriate transport destination (trauma center) should be specified in protocols.

Critical Decision Making

  • Key decisions:

    • Patient priority/severity.

    • Whether to limit scene time.

    • Which hospital/transport method is best.

  • Decisions are based on patient condition, hospital proximity, transport options, protocols, and medical direction.

Trauma Triage Guidelines (CDC)

  • Considers:

    • Physiologic determinants.

    • Anatomic criteria.

    • Mechanism of Injury (MOI).

  • Address criteria in sequence (physiologic, then anatomic, then MOI).

Physiologic Criteria

  • Altered mental status (GCS < 14).

  • Hypotension (systolic BP < 9090 mmHg).

  • Abnormal respiratory rates ( > 29 or < 10). In infants, respiratory rates < 20 are an extremely grave sign.

Anatomic Criteria

  • All penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee.

  • Chest wall instability or deformity.

  • Two or more proximal long bone fractures.

  • Crushed, degloved, mangled, or pulseless extremity.

  • Amputation proximal to wrist or ankle.

  • Pelvic fractures.

  • Open or depressed skull fracture.

  • Paralysis

Mechanism of Injury Criteria

  • Falls:

    • Adults: > 20 feet (6 meters).

    • Children: > 10 feet (3 meters) or two to three times the height of the child.

  • High-risk auto crash:

    • Intrusion > 12 inches (30 cm) occupant site or > 18 inches (45 cm) any site.

    • Ejection (partial or complete).

    • Death in same passenger compartment.

    • Vehicle telemetry data indicating high risk.

  • Auto vs. pedestrian/bicyclist thrown, run over, or with significant impact (> 20 mph / 32 kmph).

  • Motorcycle crash > 20 mph (32 kmph).

Special Patient Considerations

  • Older adults ( > 55 years old):

    • Systolic BP < 110 may indicate shock ( > 65 years old).

    • Low impact injuries (e.g., ground-level fall) may result in severe injury.

  • Children: Triage preferentially to pediatric capable trauma centers.

  • Anticoagulants and bleeding disorders.

  • Burns:

    • Without trauma mechanism: triage to burn facility.

    • With trauma mechanism: triage to trauma center.

  • Pregnancy ( > 20 weeks).

Multisystem Trauma Management

  • Prioritize life-threatening problems (ABC's).

  • Limit scene time for critical patients.

  • Rapid transport to appropriate facility (trauma center).

  • Balance scene interventions with the need for timely transport.

General Principles

  • Prepare for multisystem trauma calls by practicing with your crew.

  • Follow assessment priorities (airway, breathing, circulation).

  • Limit scene treatment to essential interventions.

  • If spinal injury is detected or strongly suspected, or when the board serves other purposes to immobilize the entire body; restrict spinal motion.

Pediatric Considerations

  • Provide additional emotional support.

  • Consider family dynamics (transport family members together when possible).

  • Protocols often consider MOI for spinal motion restriction in children because of possible communication difficulties.

  • Be aware of possible decompensation and focus on knowledge and skills to give the best care possible to the pediatric patient.

Trauma Scoring (Revised Trauma Score - RTS)

  • Evaluates:

    • Glasgow Coma Scale (GCS).

    • Systolic blood pressure.

    • Respiratory rate.

  • Used to determine if patient should go to a trauma center and to allow trauma centers to compare outcomes of trauma patients who have similar severity of injuries.