Relevance. The variety of options for combining injuries and disorders occurring in the body with a combined injury, the need for rapid decision-making on treatment require rapid diagnosis of the entire volume of injuries and determining the severity of the injury, but there is still no single protocol for examining such victims. The aim of the work was to present a modern CT study protocol for patients with concomitant trauma.Materials and methods. The results of computed tomography of 30 patients with severe concomitant trauma were analyzed. All the victims were admitted in the first hours after the injury. Men were 30 (67 %), women – 10 (33 %), the average age was 41.3 ± 7.6 (22–79) years. Traditional multiphase full-body MSCT was performed in 20 patients, in 10 patients a special protocol was used for the study of the "whole body" by the method of divided bolus.The results of the study. Craniocerebral injuries were detected in 15 (50 %), spinal injuries – in 7 (23.3 %). Simultaneous injuries to the chest and abdomen were detected in 19 (63.3 %) of the victims. When subjectively evaluated, the quality of the images obtained using the full-body MSCT protocol with bolus separation and the standard multiphase protocol for the diagnosis of traumatic injuries was equivalent. The average radiation load per patient with traditional multiphase full-body MSCT is 66 % higher than with the split-bolus protocol.Conclusions. Full-body MSCT using a split bolus is a modern technique that fully meets the diagnostic conditions for severe combined trauma and, with a decrease in the radiation dose, allows you to determine all possible injuries in the victim in a single study.

On the example of a clinical observation, we demonstrate the possibilities of dynamic multimodality imaging techniques and clinical and laboratory data, taking into account the severity of the concomitant trauma, which allow us to reflect objectively the dynamics of post-traumatic changes in the organs and tissues and predict the course of multiple organ failure (MOF). Consistency and adequate choice of treatment tactics with early use of active detoxification methods contribute to a favorable outcome.

Despite the existing progress in providing care to patients with severe multisystem chest injury using advanced diagnostic methods, a high mortality rate still reaches 20–30%.Aim of study. To assess the impact of early diagnosis and correction of chest injuries on the development of complications in patients with multisystem trauma.Material and methods. The results of diagnosis and treatment of 89 patients with severe multisystem closed chest injury were studied. According to the time of admission to the Institute, the patients were divided into two groups: Group I, who were admitted to the Institute within the first hours after the injury (51 patients), and Group II, who were transferred from other medical institutions on the 3rd–7th day (38). CT was performed as a standard method of diagnosis and monitoring the dynamics of the process. With the development of purulent-inflammatory pulmonary complications, the bacteriological test of bronchoalveolar lavage was performed. Treatment included complex intensive therapy, drainage of the pleural cavity and emergency surgical interventions, if necessary.Results. In Group I, lung contusion occurred in 43 (84%) patients, and after 7-10 days, the contusion foci partially regressed in 20 (46.5%) patients. In 8 (16%) patients with lung rupture, infiltrative changes in the lung were resolved on the 18th-30th day, while 4 (50%) of them had pneumonia outside the contusion zones. In Group II, patients were put on a ventilator and inflammatory changes in the lungs were revealed in 30 patients (79%). Lung rupture associated with the contusion was revealed in 2 (5.2%). When comparing the groups by the composition of the isolated microflora, it was found that in patients of group II, Acinetobacter spp was more often found (46.7% vs. 17.1% in group I patients, p=0.021) and Enterococcus spp. (30.0% and 8.6%, respectively, p=0.058), as well as Klebsiella pneumoniae (46.7% and 37.1%, p=0.6). At the same time, Staphylococcus aureus was not found in these patients, while it was detected in 14.3% of patients from Group I (p=0.09). Medical care in Group I was carried out according to the principles of the “golden hour”: within the first hour from the moment of admission to the patients with the presence of pneumothorax and hemothorax, the pleural cavity was drained. In Group II, this procedure was performed in other medical institutions and in 5 additional patients at the Institute.Conclusions. Early computed tomography diagnosis of multisystem trauma makes it possible to assess the severity of injuries to the chest organs and other areas of the body and determine the treatment tactics. A comprehensive approach to the management of patients, including early diagnosis of trauma, drainage of the pleural cavity, determination of management tactics, bacterial test of the lower respiratory tract discharge, helps reduce infectious complications by an average of 45.46%.

Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского, Москва Резюме. Актуальность. Многообразие вариантов сочетания повреждений и нарушений, происходящих в организме при сочетанной травме, необходимость быстрого принятия решений по лечению требуют быстрой диагностики всего объема повреждений и определения тяжести травмы, но до сих пор отсутствует единый протокол обследования таких пострадавших. Целью работы было представить современный протокол КТ-исследования для пациентов с сочетанной травмой. Материалы и методы. Проведен анализ результатов компьютерной томографии 30 пациентов с тяжелой сочетанной травмой. Все пострадавшие поступили в первые часы после травмы. Мужчин было 30 (67 %), женщин -10 (33 %), средний возраст 41,3 ± 7,6 (22-79) года. Традиционное многофазное МСКТ «всего тела» было выполнено 20 пациентам, у 10 пациентов был применен специальный протокол для исследования «всего тела» по методике разделенного болюса. Результаты исследования. Черепно-мозговая травмы была выявлена у 15 (50 %) пострадавших, повреждения позвоночника -у 7 (23,3 %). Одновременные повреждения груди и живота выявлены у 19 (63,3 %) пострадавших. При субъективной оценке качество изображений, полученных при использовании протокола МСКТ «всего тела» с разделением болюса и стандартного многофазного протокола для диагностики травматических повреждений было эквивалентно. Cредняя лучевая нагрузка на пациента при традиционном многофазном МСКТ «всего тела» (66 %) больше, чем при протоколе с использованием разделенного болюса. Выводы. МСКТ «всего тела» с использованием разделенного болюса является современной методикой, которая полностью соответствует условиям диагностики при тяжелой сочетанной травме, и при уменьшении дозы облучения позволяет в рамках одного исследования определить все возможные повреждения у пострадавшего.Ключевые слова: сочетанная травма, KT всего тела, разделенный болюс.