Risks in the Management of Polytrauma Patients: Clinical Insights

Abstract

Karthikeyan P Iyengar,1 Aakaash S Venkatesan,2 Vijay K Jain,3 Madapura K Shashidhara,4 Husam Elbana,5 Rajesh Botchu6 1Department of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK; 2Department of Orthopaedics, University Hospital Sussex, Worthing, UK; 3Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India; 4Department of Anesthesiology, Stockport NHS Foundation NHS Trust, Stockport, UK; 5Department of Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK; 6Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UKCorrespondence: Karthikeyan P Iyengar, Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, UK, PR8 6PN, Tel [phone], Email [email protected]: 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.Keywords: polytrauma, resuscitation, abbreviated injury scale, early appropriate care, trauma related coagulopathy, shock

Keywords

• polytrauma
• resuscitation
• abbreviated injury scale
• early appropriate care
• trauma related coagulopathy
• shock