Combined injury. Multiple and associated trauma

Combined trauma includes a variety of diagnoses, characteristic of people who survived after severe traumatic effects on numerous organs and areas of the body. Here, first of all, there are lesions, in which, along with complex injuries of the head and internal organs, there are serious disorders in the region of the musculoskeletal system.

The main reasons for getting co-injuries

Combined trauma most often occurs due to serious accidents, falls from a great height or because of violent actions. According to the disappointing statistics, most of the combined injuries in severe form occur on foot traffic accident participants. At the same time, the most frequent cases of death are observed when falling from a height.

If we talk about victims of violent actions, for such situations, serious craniocerebral and facial injuries are common along with injuries to the spine and internal organs.

Clinical picture

Combined trauma can differ in a variety of symptoms, which primarily depend on the location of the most critical injuries, the presence of blood loss, traumatic shock conditions, brain disorders, cardiac dysfunction, respiratory system.

The overall clinical picture in the preparation of combined injuries is determined on the basis of the leading damage, the presence of which hides a life threat. However, it is not uncommon for cases when there are several equivalent in terms of the degree of danger leading damage.

Types of combined injuries

There is a simple classification of complex combined polytrauma, which is most acceptable if it is necessary to determine the extent of damage by emergency doctors.

Based on the nature of the leading damage, the combined injuries are classified as follows:

• Open or closed traumas of the brain and skull in combination with injuries of the same nature of other areas of the body, for example, thoracic, celiac, limbs, pelvis;
• Open or closed injuries in the thoracic region, combined with craniocerebral injury;
• Open or closed injuries of the celiac, head, spine, extremities;
• Complex injuries of the spine in combination with injuries to other departments: the brain, abdomen, pelvis, chest;
• Serious damage to the pelvic region, combined with craniocerebral, celiac, thoracic injuries.

Multiple and associated trauma

The presence of multiple trauma in the presence of the victim's consciousness can lead to the formation of so-called pseudo-dominant lesions. This condition often causes the patient to focus on less serious damage, distracting the doctor from setting the right diagnosis.

To prevent a diagnostic error in obtaining multiple trauma allows an urgent manual and X-ray examination of the entire skeleton.

In the case of a lack of consciousness when receiving multiple polytrauma, a first examination is made for lesions in the thorax, spine, abdominal, cranial and pelvic bones. At the same time, the cause of x-ray diagnosis of the limbs may be the presence of abrasions, swelling, bruising, uncharacteristic for a stable state of limb mobility.

First emergency aid

Severe combined injury refers to injuries, in which the stabilization of the condition of the victim largely depends on the speed of providing the first emergency aid. To transport the patient in case of a combined trauma requires a rigid stretcher, which reduces the chance of blockage of the airways by blood, vomit, and avoiding tongue or jaw. In parallel, the area of the nasopharynx is cleaned with gauze napkins or medical suction of liquids. Severe combined injury may require the opening of the oral cavity with a special rotor-expander.

Further, if lung failure occurs, artificial mouth-to-mouth breathing or KI-3M apparatus is performed. With immediate, urgent, and most importantly, correct help, due to the above measures, the victim regains his breathing, after which a conscious state usually comes.

After the delivery of the victim to the department of a combined trauma to stabilize the vital functions of the body requires the introduction of polyglucin, prednisolone, hydrocortisone. In the presence of severe wounds of the limbs with the emergence of arterial bleeding superimposed tourniquet.

Combined trauma in children or a person in an extremely serious condition, in which low blood pressure is observed, requires the introduction of insulin, injections into the vein of 40% glucose without stopping the supply of polyglucin with hormones.

If a peripheral pulse arises and the pressure stabilizes at a level of up to 80 mm Hg, Art. In the case of combinations of fractures of the extremities, it is not advisable to spend time on tire application. Instead, the focus is on preventing the failure of vital organs.