HOW TO TREAT MULTIPLE INJURIES PATIENT /POLYTRAUMA PATIENT IN EMERGENCY

MULTIPLE INJURIES /POLYTRAUMA APPROACH TO PATIENT

WHILE EXAMINING A CASE OF INJURY TO THE MUSCULOSKELETAL SYSTEM,

ANSWER FOLLOWING QUESTIONS ARE SOUGHT:

• is there a fracture?
• is it a closed or an open fracture?
• is it a traumatic or a pathological fracture?
• are there any complications associated with the fracture? 

any type of injury  if isolated early then it rarely poses any threat ,but in association with multiple injuries,musculoskeletal injuries assume great significance in term of level of health and well-being,and to risk of death .

early management plays a vital role in improving the outcome of these patients.

FIELD TRIAGE

Field triage is the process by which emergency medical services providers decide on the destination for the injured subject. Each year, the approximately 1 million emergency medical services (EMS) providers have a substantial impact on the care of injured persons and on public health in the United States.

the management of a multiple injuried should being at the scene of accident where the medical technician should be able to work in coordination with the doctors.

he should provide basic life support and help in transportation.he should be able to decide,on the basis of the level of injury,whether the victim needs to be transferred to the local hospital or to the hospital which provide developed trauma services. in the present day trauma service s.in the present day context,trauma services are not so well developed in countries like india ,but this is something to aspire for.

TREATMENT IN THE EMERGENCY DEPARTMENT

once the patient reaches the emergency department ,management consists of following :

• PRIMARY SURVEY:this constitute rapid assessment for vitals of patient and ensuring patient airways,adequate breathing , circulation and control of extenal bleeding
• RESUSCITATION :the action or process of reviving someone from unconsciousness or apparent death.
• SECONDARY SURVEY: Once the patient is stable proper  neurologic assessment ,thoracoabdominal assessment,genito-urinary assessment and musculo-skeletal assesment is not high on priority .

          the only injuries related to musculoskeletal system are important at this stage are:a)VASULAR INJURIES -check all peripheral pulse and capillary circulation

              B)NERVE INURIES-check peripheral nerve and correct malposition of fractures to relive pressure or stretch on the affected nerve 

              C0DISLOCATION OR SUBLUXATION-these need to be correct early.

              DEFINITIVE TREATMENT : From orthopedic view point this  consists of planning whether some fractures need internal fixation.those being treated conservatively ,need to be reduce and immobilised. current trend is to internally fix as many fractures as possible is in a polytrauma pateint ,often in one sitting .

this has been shown to help in nursing care,and has resulted in decrease in mortality and morbidity.