The polytrauma patient: Current concepts and evolving care

Abstract

Principles of care in the polytraumatized patient have continued to evolve with advancements in technology. Although hemorrhage has remained a primary cause of morbidity and mortality in acute trauma, emerging strategies that can be applied pre-medical facility as well as in-hospital have continued to improve care. Exo-vascular modalities, including the use of devices to address torso hemorrhage and areas not amenable to traditional tourniquets, have revolutionized prehospital treatment. Endovascular advancements including the resuscitative endovascular balloon occlusion of the aorta (REBOA), have led to dramatic improvements in systolic blood pressure, although not without their own unique complications. Although novel treatment options have continued to emerge, so too have concepts regarding optimal time frames for intervention. Though prior care has focused on Injury Severity Score (ISS) as a marker to determine timing of intervention, current consensus contends that unnecessary delays in fracture care should be avoided, while respecting the complex physiology of certain patient groups that may remain at increased risk for complications. Thromboelastography (TEG) has been one technique that focuses on the unique pathophysiology of each patient, providing guidance for resuscitation in addition to providing information in recognizing the at-risk patient for venous thromboembolism. Negative pressure wound therapy (NPWT) has emerged as a therapeutic adjuvant for select trauma patients with significant soft tissue defects and open wounds. With significant advancements in medical technology and improved understanding of patient physiology, the optimal approach to the polytrauma patient continues to evolve.

Immune dysfunction following severe trauma: A systems failure from the central nervous system to mitochondria

“…In patients who survive the first few hours of hospital admission, complications can occur at different times (Figure 1) (3). The first window is 3-6 to 24 h where CNS dysfunction (∼50% of early deaths) and circulatory collapse (usually manifesting as shock) lead to early deaths (40% of early deaths) (Figure 1) (4)(5)(6). The second window occurs over the next few weeks and typically involves infectious complications with a prolonged indolent form of multiple organ failure, immunosuppression and sepsis, referred to as Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PIICS) (∼20% of deaths) (Figure 1) (4,7,8).…”

Nursing interventions and activities for patients with multiple traumas: An integrative review

“…The activities that were not based on NIC are as follows: advise the nursing staff to carry out observation during mobility events; Identify and communicate problems; and assist when necessary (Gnass et al., 2018; Klein et al., 2018); sit the patient for 1–2 h/day (Timmerman, 2007); use the progressive mobility protocol (Timmerman, 2007); plan placement procedures carefully in advance and look for the appropriate number of people with the necessary experience to help make position changes (Christie, 2008); assess functional status and ability to perform activities of daily living/instrumental activities of daily living (Cobb & Pridgen, 2008); review capacity on current activity and tolerance (Cobb & Pridgen, 2008); assess the patient/family's ability to understand injuries, the recovery/rehabilitation process (Cobb & Pridgen, 2008); conduct reality orientation (Almeida et al., 2010; Fries, 2009); determine amount and type of assistance needed (Bertoncello et al., 2013); provide assistance in daily life activities (Gnass et al., 2018); advise the patient on all appropriate techniques, aiming to achieve the highest level of independence and demonstrate it, as appropriate (Bertoncello et al., 2013); to promote the patient actively involved, the intervention is not only focused on delivering care but tends to educate and train the patients on how to accomplish (Gutenbrunner et al., 2021); to apply an early mobilization protocol (Coles et al., 2020); to make a decision on a triage category, to monitor changes in vital functions, to apply therapy, and to document everything in the nursing documentation (Lovrenčić & Rotim, 2019); and to apply the negative pressure wound therapy that has become a staple treatment in polytrauma patients with severe soft tissue injuries (Lee et al., 2021).…”

“…to achieve the highest level of independence and demonstrate it, as appropriate (Bertoncello et al, 2013); to promote the patient actively involved, the intervention is not only focused on delivering care but tends to educate and train the patients on how to accomplish (Gutenbrunner et al, 2021); to apply an early mobilization protocol (Coles et al, 2020); to make a decision on a triage category, to monitor changes in vital functions, to apply therapy, and to document everything in the nursing documentation (Lovrenčić & Rotim, 2019); and to apply the negative pressure wound therapy that has become a staple treatment in polytrauma patients with severe soft tissue injuries (Lee et al, 2021).…”

Medical-nutrition therapy in polytraumatized patients: a race against time

“…The injuries often include spinal, cranioencephalic, thoracic, pelvic, abdominal, and limb traumas. A total of 80% of all deaths occur within 60 min after the injury, which is why health care professionals must undertake a series of coordinated measures for damage control, as well as to provide prompt care due to the high morbidity and mortality rates involved 1,2 .…”