Multiple injury refers to the injury that causes two or more anatomical parts or organs of the body under the action of the same injury factor, at least one of which may endanger life.Multiple injuries are different from multiple injuries. The former refers to serious injuries to more than two anatomical parts or organs, while the latter refers to injuries to the same part or organs at more than two places.
TCM disease name
Multiple injuries
Visiting department
General surgery
Common causes
It is commonly seen in traffic accidents, explosive accidents, mine accidents, and falls above the ground. Some patients may also have multiple injuries when falling on the ground or from bicycles
common symptom
Multiple injuries: multiple trauma sites, severe injuries, severe tissue destruction, often accompanied by hemorrhagic shock or traumatic shock, immune dysfunction, high metabolic status
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The certification expert of this term is
Zhu Zhijun|Chief physician
General Surgery Department of Zhejiang Provincial Hospital of Traditional Chinese Medicineto examine
It is commonly seen in traffic accidents, explosive accidents, mine accidents, and falls above the ground. Some patients may also have multiple injuries when falling on the ground or from bicycles
common symptom
Multiple injuries: multiple trauma sites, severe injuries, severe tissue destruction, often accompanied by hemorrhagic shock or traumatic shock, immune dysfunction, high metabolic status
pathogeny
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It is commonly seen in traffic accidents, explosive accidents, mine accidents, and falls above the ground. Some patients may also have multiple injuries when they fall on the ground or from bicycles.Multiple injuries are characterized by multiple trauma sites, severe injuries, severe tissue destruction, often accompanied by hemorrhagic shock or traumatic shock, immune dysfunction, hypermetabolism, and even multiple organ dysfunction syndrome (MODS).
clinical manifestation
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The clinical manifestations are closely related to the location of the injury. For example, the head injury is mainly manifested by the change of consciousness, and coma may occur in severe cases;Face and neck trauma can cause airway obstruction and asphyxia;The most common manifestations of chest trauma are rib fracture, hemopneumothorax and lung contusion;Abdominal multiple injuries are commonly seen in internal bleeding caused by solid organ rupture and peritonitis caused by cavity organ rupture.In addition, multiple injuries are easy to cause hemorrhagic shock or traumatic shock, severe hypoxemia, cardiac tamponade, traumatic myocarditis, infection, MODS, etc.The clinical characteristics of multiple injuries are as follows.
1. Rapid change of injury condition and high mortality rate
Multiple injuries seriously affect the physiological function of the body. The body is in a state of overall stress, and the interaction of injuries at several parts of the body can easily lead to rapid deterioration of the injury, serious pathophysiological disorders and life-threatening.The main causes of death of multiple injuries are mostly severe brain injury and chest injury.
2. Serious injury and high shock rate
Multiple injuries are serious, multiple, extensive, and bleeding, and can even directly interfere with the functions of the respiratory and circulatory systems and threaten life, especially shock.
3. Complicated injuries, easy to miss diagnosis
The common characteristics of multiple injuries are that there are many injured parts, complicated injuries, obvious injuries and concealed injuries, open injuries and closed injuries, and most of the wounded can not describe the injuries. In addition, all specialists pay more attention to the injuries of their own specialties and ignore other department's diagnosis, resulting in missed diagnosis.
4. Complicated injuries and contradictions
Multiple injuries often require surgical treatment due to multiple injuries, but there are still contradictions in the order of surgery.If you have no experience, you don't know where to start.At this time, the medical staff should decide the sequence of operation sites according to the injury condition of each part, the degree of life impact, the different organs involved and the depth of tissues, so as not to miss the rescue opportunity.
5. Low resistance and easy infection
When multiple injuries are in a stress state, their general resistance is low, and most of them are open wounds. Some wounds are especially polluted and easily infected.
Multiple injuries have three death peaks.
The first death peak: it occurs within a few minutes after the injury, which is immediate death.The main causes of death were severe trauma to the brain, brain stem, high spinal cord, or tearing of large blood vessels such as the heart aorta, often too late for rescue;The second death peak: it occurs within 6-8 hours after the injury, which is called the "golden time" for rescue. The main causes of death are intracerebral, subdural and epidural hematoma, hemopneumothorax, rupture of liver and spleen, pelvic and femoral fractures, and multiple injuries and massive bleeding.If the rescue measures are prompt and appropriate, most patients can avoid death.This kind of patient is the main object of rescue;The third death peak: it occurs in days or weeks after injury, and the cause of death is severe infection or organ failure.No matter how to rescue patients with multiple injuries before or in hospital, attention must be paid to preventing the third death peak.
inspect
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First of all, the injured person should be quickly examined, especially for vital signs and bleeding such as consciousness, face color, respiration, blood pressure, pulse, pupil, etc., to confirm whether the injured person has fatal injuries such as respiratory tract obstruction, shock, massive bleeding, etc.For patients with sudden cardiac and respiratory arrest, cardiopulmonary resuscitation should be carried out immediately;In case of unconsciousness, keep the respiratory tract unobstructed, observe and record the changes of the patient's mind, pupil, respiration, pulse and blood pressure, after the vital signs are stable, further inquire about the medical history, and conduct careful physical examination, laboratory examination and special examination to obtain the most accurate diagnosis as possible.Multiple injury is a kind of dynamic injury with complex changes. The conclusions drawn from the initial examination may be incomplete, and dynamic observation must be carried out.
diagnosis
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Those who meet the following 2 or more injury conditions can be diagnosed as multiple injuries.
1. Cranial injury: skull fracture, with coma and semi coma intracranial hematoma, brain contusion, maxillofacial fracture.
2. Neck injury: neck injury with large vessel injury, hematoma, and cervical spine injury.
3. Chest injury: multiple rib fractures, hemopneumothorax, lung contusion, rupture of heart, large blood vessels, trachea, and diaphragmatic hernia.
4. Abdominal injury: intraperitoneal hemorrhage, abdominal organ rupture, retroperitoneal hematoma.
5. Urogenital system injury: kidney rupture, bladder rupture, uterus rupture, urethra rupture, vagina rupture, etc.
6. Complex pelvic fracture or shock.
7. Spinal fracture, dislocation with spinal cord injury or multiple spinal fractures.
8. Limb injuries: upper limb scapula, long bone fracture, upper limb amputation;Long tubular shaft fracture of lower limb, lower limb broken;Extensive skin avulsion injury of limbs.Simple spinal compression fracture, mild soft tissue contusion, hand and foot fracture, etc., due to little impact on the whole, should not be diagnosed as multiple injuries.
treatment
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1. Emergency rescue principle
(1) Diagnosis after processing, and diagnosis while processing.
(2) Serious cases that can be quickly killed and reversed shall be dealt with first.
1) Obstruction of the upper respiratory tract is the most common ventilatory disorder. If the blockage cannot be removed in time, no rescue will be effective.
2) Circulatory disorders: ① hypovolemia: multiple trauma bleeding is very common, both internal and external bleeding can lead to hypovolemic shock.If the treatment measures are not effective, it will enter an irreversible state, and death is inevitable; ②Heart failure and cardiac arrest: sudden attack of multiple injuries can lead to cardiac arrest, and heart failure can also be caused by many other comprehensive factors. If this situation can be handled in time, most of it can be quickly reversed; ③Tension pneumothorax: because of the obvious compression of the chest gas on the heart and lungs, it can seriously interfere with the respiratory and circulatory functions, and can quickly kill; ④Open pneumothorax: open pneumothorax makes the mediastinum swing back and forth, seriously interfering with cardiopulmonary function and causing death; ⑤Flail chest: due to multiple segmental rib fractures, local chest wall loses its support function, which forms an abnormal movement relative to the respiratory movement, seriously affecting the cardiopulmonary function and causing death; ⑥Pericardial tamponade: pericardial tamponade significantly affects venous return, resulting in serious insufficiency of cardiac output, which eventually leads to death.
3) Bleeding is not only internal bleeding or external bleeding, but also the cause of death if the bleeding is not continuous and the amount of bleeding is large.During on-site first aid, if the blood volume and blood pressure cannot be improved after a large amount of blood volume supplementation, the possibility of bleeding should be considered and the causes should be investigated: ① check the wound to see if the external bleeding stops; ②Whether there is thoracic hemorrhage, such as vascular rupture of chest wall; ③Whether there is bleeding in the abdomen, such as rupture of liver and spleen; ④Whether there is retroperitoneal hemorrhage, such as kidney injury, pelvic fracture, etc. ⑤If large blood vessels are damaged by limb fractures, there will be a large amount of bleeding, local formation of large hematoma, and the hematoma will continue to expand.
2. Treatment of injured organs after stable vital signs
(1) Brain injury: pay attention to prevent brain edema, limit the amount of infusion, and remove intracranial hematoma as early as possible.
(2) Chest injury: positive pressure ventilation of ventilator, closed thoracic drainage for patients with hemopneumothorax;The injured heart should be repaired in time.
(3) Abdominal injury: treat according to the injured organs, and perform exploratory laparotomy if necessary.
(4) Limbs, pelvis and spinal cord injuries: early debridement and fixation of fractures, combined with vascular, neural and pelvic visceral injuries, early surgical treatment.
3. Principles of surgical treatment
The operation sequence is mainly determined by the severity and importance of the injured organ, and is generally carried out in the order of urgency, urgency and timing.
