TRIMODAL DEATH TRIMODAL DEATH DISTRIBUTIONDISTRIBUTION

50%

40%

30%

20%

10%

0%

HOURS 0 1 2 3 4 WEEKS 1 2 3 4

TRIMODAL BIMODAL?THE SECOND GROUP IS DECREASING DUE TO PROPER TREATMENT

DEFINITION OF POLYTRAUMADEFINITION OF POLYTRAUMA

A. INJURY TO ONE OR MORE BODY REGIONS OR ORGANS OF WHICH ONE, OR THEIR COMBINATIONS IS LIFE THREATENING

B. INJURY TO MORE BODY REGIONS FOLLOWING WHICH, DURING TREATMENT, WE HAVE TO MAKE COMPROMISES

C. INJURY TO HOLLOW ORGANS + INJURY TO EXTREMITIES

D. INJURY DEFINED BY SCORING SYSTEM

INJURY SEVERITY SCORE (ISS)INJURY SEVERITY SCORE (ISS)

SIX REGIONSTHE THREE MOST SEVERE THE SQUARE OF EACH VALUETHE SUM OF THE RESULTS

•HEAD AND NECK•FACE•CHEST•ABDOMEN•EXTREMITIES (PELVIS)•SKIN

DEFINITION OF POLYTRAUMADEFINITION OF POLYTRAUMA

A. INJURY TO ONE OR MORE BODY REGIONS OR ORGANS OF WHICH ONE, OR THEIR COMBINATIONS IS LIFE THREATENING

B. INJURY TO MORE BODY REGIONS FOLLOWING WHICH, DURING TREATMENT, WE HAVE TO MAKE COMPROMISES

C. INJURY TO HOLLOW ORGANS + INJURY TO EXTREMITIES

D. INJURY DEFINED BY SCORING SYSTEM

ATLS ATLS CONCEPTIONCONCEPTION

ADVANCED TRAUMA LIFE SUPPORT ABCDEABCDE APPROACH APPROACHFIRST THE LIFE THREATENING FIRST THE LIFE THREATENING INJURYINJURYTHE IMMEDIATE EXACT DIAGNOSIS THE IMMEDIATE EXACT DIAGNOSIS

IS NOT IMPORTANTIS NOT IMPORTANTTHE TIME FACTOR IS THE MOST THE TIME FACTOR IS THE MOST IMPORTANTIMPORTANTDO NOT DO MORE HARMDO NOT DO MORE HARM

THE CAUSE OF SHOCKTHE CAUSE OF SHOCK

BLEEDING NON BLEEDING

BLEEDING TENSION PTX (FAST) CARDIAC TAMP. FOCUSED CARDIOGENIC ASSESSMENT NEUROGENIC SONOGRAPHY in SEPTIC TRAUMACHEST, PELVIS X-RAY

PATIENT RESPONSEPATIENT RESPONSE

„RAPID RESPONDER”CRISTALLOIDS

„TRANSIENT RESPONDER”CRISTALLOIDS, TRANSFUSIONPATIENT RESPONSE?

„NON-RESPONDER”CRISTALLOID, IMMEDIATE TRANSFUS.SURGERY

SECONDARY SURVEYSECONDARY SURVEY

AMPLEA ALLERGIESM MEDICATIONSP PAST ILLNESSESL LAST MEALE EVENTS/ENVIRONMENT

THERAPEUTIC WINDOWSTHERAPEUTIC WINDOWS

1.1. FIRST 24 (48) HOURSFIRST 24 (48) HOURS2.2. 5-7 DAYS5-7 DAYS FOLLOWING INJURYFOLLOWING INJURY3.3. 2-3 WEEKS2-3 WEEKS

ABDIMINAL THORACIC, BRAIN INJURIESABDIMINAL THORACIC, BRAIN INJURIES

EXTREMITIESEXTREMITIESVESSEL, NERVE INJURIES VESSEL, NERVE INJURIES INTRAMEDULLARY STABILISATIONINTRAMEDULLARY STABILISATIONEXTERNAL FIXATEUREXTERNAL FIXATEUR

MOF AND SIRSMOF AND SIRSMULTIPLE ORGAN FAILURE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

MOF HYPOXIA, HYPOPERFUSION, („FIRST HIT”)BACTEREMIA TOXINS – BOWEL HYPOPERFUSION („SECOND HIT”)FRACTURE OF LONG TUBULAR BONESMEDIATORS

SIRS TWO OR MORE OF THESE FACTORS

•FEVRE HIGHER THAN > 38 OR < 36•TACHYPNOE > 24/MIN•TACHYCARDIA > 90/ MIN•LEUCOCYTOSIS >12 000/ MM3•LEUCUPENIA > 4000 OR JUVENILE CELLS MORE THAN 10%

SHOCK

TRIAGETRIAGE

A.A. DEGREE OF LIFE THREAT POSED BY THEDEGREE OF LIFE THREAT POSED BY THE INJURYINJURY

B.B. INJURY SEVERITYINJURY SEVERITYC.C. SALVAGEABILITYSALVAGEABILITYD.D. RESOURCES AVAILABLERESOURCES AVAILABLEE.E. TIME, DISTANCE, ENVIRONMENT TIME, DISTANCE, ENVIRONMENT