Multisystem Trauma

Question 1

Multisystem Trauma

Answer 1

• Patient with one or more injuries serious enough to affect more than one body system

Question 2

Factors in Determining Patient Severity Multisystem Trauma

Answer 2

• Physiologic criteria
• Anatomic criteria
• Mechanism of injury

Question 3

Physiologic criteria - Determining Patient Severity Multisystem Trauma

Answer 3

• Physiologic criteria
– Altered mental status (GCS <90mmHg): shock, internal bleeding
– Abnormally slow respiratory rate: head injury, later stages of shock
– Abnormally high respiratory rate: shock

Question 4

Anatomic criteria - Determining Patient Severity Multisystem Trauma

Answer 4

• Injury to specific a body part/area requiring immediate surgical intervention
• Injuries to the head and chest
• Multiple musculoskeletal injuries
• Amputations
• Severely mangled extremities
• Pelvic injuries

Question 5

MOI - Determining Patient Severity Multisystem Trauma

Answer 5

• In absence of anatomic or physiologic signs, MOI is considered if severe
• Fall
• High-risk auto crash
• Automobile-pedestrian crash
• Motorcycle crash

Question 6

Preparing for Multisystem Trauma Patients

Answer 6

• Practice with crew: determine roles

* En route to call, review roles each member of the crew will have

Question 7

Scene Safety for Multisystem Trauma Patients

Answer 7

• Scene safety is paramount
• Different trauma is associated with different dangers
• Auto crash will have passing traffic
• Penetrating trauma—assailant may still be on the scene

Question 8

Treating Multisystem Trauma Patients

Answer 8

• Follow priorities determined by primary assessment
• Attend to threats to life
• Reassess what to treat on scene and what needs definitive care
• Call hospital so they can prepare
• Postpone vital - Alert Hospital

Question 9

Treating Multisystem Trauma Patients

Answer 9

• Limit scene treatment
– Suction airway
– Insert oral or nasal airway
– Restore patent airway
– Ventilate with bag-valve mask
– Administer oxygen
– Control bleeding
– Immobilize patient

Question 10

Managing Multisystem Trauma Patients

Answer 10

• Adapt to situation
• Do what is necessary to ensure an open airway
• Perform urgent or emergency moves as necessary
• If part of patient’s body is not accessible, assess part of the body you can reach

Question 11

Trauma Scoring

Answer 11

• Numerical rating system for trauma
• Assigns number to certain patient characteristics to create a score
• Objectively describes severity
• Helps determine transport to a trauma center or local hospital
• Helps trauma centers evaluate the care of similar patients

Question 12

Revised Trauma Score (RTS)

Answer 12

• Components
– Glasgow Coma Scale (GCS)
– Systolic blood pressure
– Respiratory rate
• Follow local protocol for use of the trauma scoring system
• Do not let it interfere with patient care

Question 13

Chapter Review: Multisystem Trauma

Answer 13

• Multisystem trauma is a serious condition in which two or more major body systems are injured or affected.
• Recognizing multisystem trauma, triaging properly, transporting promptly, and choosing the correct destination are vital for the survival of your patient.
• The CDC has issued guidelines for trauma triage and transport. These are a guide and should be used in conjunction with your protocols.
• The revised trauma score (RTS) is one method of classifying trauma patients by severity and includes the Glasgow Coma Score (GCS), systolic blood pressure, and respiratory rate.

Question 14

Remember: Multisystem Trauma

Answer 14

• Your primary assessment should determine whether your patient is seriously injured or potentially seriously injured.
• Limit scene treatment to life-threatening conditions.
• The “golden hour” begins from the time of trauma.
• Use patient severity (physiologic criteria, anatomic criteria, MOI) to decide whether to transport to a trauma center or local hospital.

Question 15

Questions to Consider: Multisystem Trauma

Answer 15

• Is my patient seriously injured or potentially seriously injured?
• Should I expedite my scene time?
• What is the most appropriate transport destination for my patient?

Question 16

Critical Thinking: Multisystem Trauma
• A patient was involved in a car crash with significant intrusion into the area where the patient was sitting. The patient is alert
and complains of pain in the ribs. Pulse: 96 and regular; respirations: 30 and adequate; blood pressure: 100/62; pupils:
equal and reactive; skin: cool and dry.
• Your partner says the patient is stable and could be easily transported to the community hospital nearby. You think the
patient should be transported to the trauma center. How would you justify your decision to your partner?

Answer 16

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