Combined trauma includes a wide variety of diagnoses that are characteristic of people who survived after severe traumatic influences on numerous organs and areas of the body. Here, first of all, injuries are distinguished, in which, along with complex injuries of the head and internal organs, there are serious violations in the area of the musculoskeletal system.
The main reasons for receiving combined injuries
Combined injury most often occurs as a result of serious accidents, falls from a great height or due to violent acts. According to disappointing statistics, the majority of severe injuries associated with injuries occur on foot of road 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 acts, then such situations are characterized by serious craniocerebral and facial injuries along with damage to the spine and internal organs.
Clinical picture
Combined trauma can differ in a wide variety of symptoms, which depend primarily on the location of the most critical injuries, the presence of blood loss, traumatic shock conditions, disorders of the brain, impaired heart function, and respiratory system.
The overall clinical picture when receiving combined injuries is determined on the basis of the leading damage, the presence of which conceals a threat to life. However, there are frequent cases when there are several leading damages of the same degree of danger.
Types of associated injuries
There is a simple classification of complex combined polytrauma, which is most acceptable if it is necessary to determine the degree of damage by emergency doctors.
Based on the nature of the lead damage, combined injuries are classified as follows:
- open or closed injuries of the brain and cranial box in combination with injuries of the same nature of other areas of the body, such as the chest, celiac, extremities, pelvis;
- open or closed injuries in the chest area, combined with craniocerebral injuries;
- open or closed injuries of the celiac cavity, head, spine, limbs;
- complex spinal injuries in combination with injuries of other departments: brain, abdomen, pelvis, chest;
- serious damage to the pelvic region, combined with craniocerebral, celiac, and chest injuries.
Multiple and combined injury
The presence of multiple injuries in the presence of the victim’s consciousness can lead to the formation of so-called pseudo-dominant injuries. This condition often makes the patient focus on less severe injuries, distracting the doctor from making the correct diagnosis.
An urgent manual and X-ray examination of the entire skeleton allows to prevent a diagnostic error when receiving multiple injuries.
In the absence of consciousness when receiving multiple polytrauma, first of all, an examination is carried out for damage to the chest, spine, abdominal cavity, cranial and pelvic bones. At the same time, the presence of abrasions, edema, and hematomas, which is uncharacteristic of a stable state of limb mobility, may be the reason for performing X-ray diagnostics of the limbs.
First aid
Severe concomitant injury refers to damage in which the stabilization of the condition of the victim largely depends on the speed of first aid. To transport the patient in the event of a combined injury, a rigid stretcher is required, which reduces the likelihood of clogging of the respiratory tract with blood, vomit, and also avoids the retraction of the tongue or lower jaw. In parallel, the nasopharynx area is cleaned with gauze napkins or medical suction of liquids. Severe concomitant injury may require the opening of the oral cavity with a special expander.
Further, in case of lung failure, mouth-to-mouth artificial respiration or using the KI-ZM apparatus is performed. With immediate, urgent, and most importantly, correct help, due to the implementation of the above measures, the patient's breathing is restored, after which a conscious state usually sets in.
After the victim is delivered to the combined trauma unit, the introduction of polyglucin, prednisone, hydrocortisone is required to stabilize the vital functions of the body. In the presence of severe limb wounds with the occurrence of arterial bleeding, a tourniquet is applied.
Combined trauma in children or in a person in an extremely serious condition, in which low blood pressure is observed, requires the introduction of insulin, injections of 40% glucose into the vein without stopping the supply of polyglucin with hormones.
When a peripheral pulse occurs and pressure stabilizes at a level of up to 80 mm Hg. Art. in the case of combinations of limb fractures, it is not recommended to spend time laying tires. Instead, the focus is on preventing the failure of vital organs.