Multi-trauma

What is Multi-trauma?

Multi-trauma may be defined as physical insults or injuries occurring simultaneously in several parts of the body. The multi-trauma patient has usually sustained multiple traumatic injuries to the body, affecting different organs and body systems. The multi-trauma patient may have a head injury, multiple fractures, and injury to the internal organs of the chest or abdomen. The more body systems involved usually indicates more serious illness.

Trauma

• Trauma is usually categorised as blunt or penetrating. Blunt injuries are a type of physical trauma caused by impact or other force applied from or with a blunt object. Penetrating injuries are caused when the body is pierced by an object, and may be caused by injuries such as stabbings and gunshot wounds. Assessment and diagnosis of blunt injuries are more difficult than of penetrating injuries, because blunt injuries are not usually internal, and not obvious.

• Trauma accounts for a significant proportion of annual deaths world-wide. The World Health Organization (WHO) estimates that in the year 2000, 5 million people died of injuries, accounting for 9% of global annual mortality. That same year, 12% of the global burden of disease resulted from injury. Over 90% of the world’s trauma mortality occurs in low- and middle-income nations, with those in Eastern Europe having the highest rates. Almost 50% of those who die are between 15 and 44 years of age, with males accounting for twice as many deaths as females. Violence—self-inflicted, interpersonal, and war-related—accounts for half of trauma mortality, with 1.6 million deaths in the year 2000. Road traffic accounts for the next largest proportion, roughly 1.2 million deaths, per year, 2.1% of overall mortality. An additional 20 to 50 million people are injured annually in road traffic incidents. Though most of the world’s trauma deaths occurs in developing countries, trauma is a significant cause of injury and death in industrialised nations as well. Road traffic accidents, including motor vehicle, motor bikes and pedestrians are the most common causes of trauma requiring admission into intensive care in Australia.

Mechanism of injury

The extent of a patient’s injuries depends on the Mechanisms of Injury. Mechanisms of Injury are the exchange of forces between environment and person that result in injury. The transfer of kinetic energy, or energy of motion (shock wave) to tissues results in injury. There are many different types of energy agents, including:

1. 1. Mechanical or kinetic energy- blunt or penetrating injury
   2. Thermal energy- injury due to heat or cold
   3. Chemical energy- acid or alkaline exposure
   4. Radiant energy- exposure to radiation
   5. Electrical energy- electrocution
   6. Oxygen deprivation- smoke inhalation or drowning

Mechanism of injury details provide clues to the patients injuries and extent.

Top ^

What happens in the Intensive Care Unit?

• Monitoring of the heart rate, blood pressure, oxygen saturation and temperature. This will be seen on a bedside monitor.
• An arterial line may be inserted to monitor blood pressure and to take blood samples.
• Medication and intravenous fluids may be given via a central venous catheter including sedatives (to assist in sleep), analgesics (pain killers) and antibiotics (for infections). These medications will be given via infusion pumps.
• Oxygen may be delivered via a face mask, and mechanical ventilation via an endotracheal tube or tracheostomy may be required to assist with breathing. The ventilated patient will require suctioning to remove secretions from the lungs and airways.
• If the patient has a head injury they may have monitoring of the pressure in their brain (ICP monitoring).
• Nutrition may be given via a nasogastric tube. This is a tube that is placed in the nose and goes down the throat into the stomach. Fluid can also be removed from the stomach via the nasogastric tube.
• Insertion of an indwelling catheter to drain and measure urine output.
• Drains may be used to drain excess fluids/blood from the body.
• Chest x rays and other tests such as blood tests.
• Sequential compression devices may be put on the legs to prevent the formation of blood clots.
• Warming /cooling blankets may be needed to regulate the body temperature.
• An air mattress may be used to prevent pressure areas developing on the skin.

Top ^

What are the complications of multitrauma?

• Pain- It is common for the multi trauma patient to experience pain, so providing the patient with analgesia (pain medication) is an important aspect of looking after the multi-trauma patient.
• Haemorrhage- losing large amounts of blood can result in shock. Other complications can also arise after massive blood transfusions.
• Infection/ Sepsis- the presence of open wounds increase the risk of infection.
• Multi organ failure- severe haemorrhage and injury to multiple organs increase the risk of multi organ failure. The patient with multi organ failure may require dialysis to support the kidneys, mechanical ventilation to support the lungs, and inotropic drugs to support the heart so that blood may be pumped effectively to all the organs of the body.

How long will the patient remain in ICU?

A patient’s stay in ICU may vary from a few days to a few months, depending on what their injuries are. Please ask the ICU nurse or doctor if you have any questions.

Reference

Kauvar D, Lefering R &Wade C (2006) Impact of Hemorrhage on Trauma Outcome: An Overview of Epidemiology, Clinical Presentations and Therapeutic Considerations, 60(6): S3-S11

The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.

Multi-trauma Version 1
Author Kathleen Ryan CNC ICCMU
First published August 2008

Top ^