The causes of polytrauma are usually accidents, for example in traffic, at work, at home or during sport. The symptoms depend on which organs and structures are injured. They range from massive bleeding, burns and severe craniocerebral injuries to severed limbs. Doctors must treat seriously injured people immediately – at the scene of the accident. Even if the type and severity of the injuries have not yet been determined. This is the only way they can often still save lives in the event of a polytrauma.
What is a polytrauma?
A polytrauma means that several organ systems and structures of the body are injured. The term is derived as follows: “poly” means “multiple” and the word “trauma” stands for injury. The definition of a polytrauma is when at least one injury or several injuries in combination are life-threatening. People with polytrauma fall into the category of “severely injured”. At the scene of an accident, it is important that emergency doctors recognize this situation quickly. In hospital, it is often life-saving when specially trained traumatologists diagnose the individual injuries precisely and treat them specifically according to the severity of the injury, often by means of surgery.
The most common causes of polytrauma are traffic accidents, for example with a car, truck, bus, motorcycle, scooter or bicycle. But sports, occupational and household accidents can also cause polytrauma. What they all have in common is that the human body suffers massive damage. Polytrauma can affect the skin, all bones, joints, muscles, tendons, tissue and internal organs. The injured suffer fractures, bruises, contusions or ruptures in organs and blood vessels. Internal bleeding is therefore often the result. They can quickly cost lives if treatment is not started immediately.
The symptoms depend on the type and severity of the polytrauma. Which and how many organs and structures are damaged plays a role. Polytrauma cannot always be recognized with the naked eye due to open wounds, bones protruding through the skin or injuries to the skull and brain. Massive bleeding or the amputation of limbs also suggest a polytrauma. In some situations, doctors assume a polytrauma to be on the safe side, for example if a vehicle occupant has been thrown out of the car in a collision.
The treatment of the most seriously injured begins at the scene of the accident and proceeds in several phases: Emergency therapy and stabilization of the injured person at the scene of the accident, transport to a trauma center, treatment in the shock room by a specialist trauma team and later in the intensive care unit. This often helps to save the lives of accident victims.
Polytrauma – frequency and age
According to statistics, around 30 percent of all injuries in Switzerland are life-threatening. The victims are considered to be seriously injured. In Switzerland, polytrauma patients are treated in one of the twelve hospitals that have been commissioned within the framework of highly specialized medicine (HSM). Among them is the University Hospital Zurich. According to the Swiss Trauma Registry, around 2,500 patients with polytrauma or severe traumatic brain injury are treated in a specialized trauma center.
Polytrauma is not a question of age or gender. Accidents, for example in road traffic, sport, at work or at home, can happen at any age. They affect babies, children, adolescents, adults and the elderly. But male adolescents and young adults in particular have a high risk of polytrauma. They are often more willing to take risks.
Polytrauma: Causes are accidents
The causes of polytrauma are usually accidents in which massive forces act on the human body, for example acceleration forces in a car accident. Some examples of situations in which serious injuries can occur:
- Traffic accidents, for example involving a car, truck, motorcycle, scooter, bicycle, bus or streetcar
- Sports accidents: Mountaineering, hiking or climbing can quickly become fatal if a person falls from a great height. The same applies to hang gliding, paragliding, base jumping, parachuting, motorized flying and gliding. But ice hockey players and boxers also live dangerously and have an increased risk of polytrauma.
- Household accidents, e.g. a fall from a high ladder (more than three meters) or from a window
- Occupational accidents, e.g. falling from scaffolding or injuries caused by an explosion, intense heat, chemical substances or radiation
- Brawls, violent crime
- Wars Terrorist attacks and military conflicts, such as bombings, explosions and flying fragments
- Suicide attempts
Symptoms: Polytrauma means danger to life
All structures and organs of the body can be injured in a polytrauma: Head, chest, spine, abdominal region, extremities and soft tissues such as tissue, muscles and tendons. Some suffer severe craniocerebral trauma in an accident, which damages the bony skull and the sensitive brain.
A polytrauma can sometimes be suspected at first glance based on the appearance and symptoms. Emergency physicians and often laypersons can do this. The following symptoms indicate a serious injury:
- Large, open wounds, for example on the neck, chest or abdomen
- Massive bleeding
- Fractures of larger bones, such as the leg or pelvis – sometimes the bones are also visible from the outside
- Obvious injuries to the head and brain
- Amputated limbs
- Extensive skin burns
- Disturbed breathing
- Impaired heart function
- Clouded consciousness, unconsciousness
Emergency physicians always assume a polytrauma in certain situations until they have established the opposite. A serious injury therefore exists if a person
- has suffered an injury involving high speed,
- was thrown out of the car in a traffic accident,
- another person in the same vehicle or the other party involved in the accident is no longer alive,
- was run over, for example by a car, truck or streetcar,
- fell more than three meters into the depth,
- was affected by an explosion, a chemical accident or released radiation.
Polytrauma: Diagnosis with us
A polytrauma is usually life-threatening. Emergency doctors must therefore make their assessment quickly and begin treatment in order to save the life of the seriously injured person. As a rule, we proceed in several steps when diagnosing a polytrauma. The so-called ABCDE scheme provides orientation:
- A – Airway: Secure or restore the airway, immobilize the cervical spine.
- B – Breathing: Ensure sufficient gas exchange.
- C – Circulation: Ensuring blood circulation and thus the supply of oxygen and nutrients to organs and tissues.
- D – Disability: e.g. check consciousness and pupillary reflexes, recognize neurological deficits and signs of intoxication.
- E – Environment: Completely undress and physically examine the victim, maintain body temperature, treat non-life-threatening injuries.
Assessment of vital functions
Vital bodily functions include breathing, cardiovascular activity (pulse, blood pressure) and body temperature, as well as the state of consciousness. We check whether the injured person reacts to being approached and touched. You can see, hear and feel the breathing movements, noises and pulses. It also looks for signs of life such as movement and skin color.
Monitoring of vital functions
- Cardiac activity can be recorded using electrocardiography (ECG).
- We can check the state of consciousness with the help of the Glasgow Coma Scale (GCS). This is based on a specific evaluation scheme for disorders of consciousness and brain function following a traumatic brain injury.
- We also determine your blood pressure. In severely injured patients, invasive (“bloody”) blood pressure measurement may also be necessary in order to monitor blood pressure continuously.
- We also measure the oxygen saturation in the blood using pulse oximetry.
Physical examination
We completely undress the injured person and examine him or her physically from head to toe. We pay attention to visually recognizable injuries such as open wounds, bleeding or bruising (haematomas). We also palpate the body and feel for swelling or broken bones and ribs. We also listen to the heart and lungs and palpate certain areas of the body.
Imaging procedures – Aids for diagnosis
Imaging procedures are used in hospital to determine the type and extent of the polytrauma in more detail. The following methods provide further insights:
- X-ray examination: This can be used to detect injuries to the chest, pelvis or spine
- Ultrasound examination (sonography): We examine the heart and abdomen to detect internal injuries and fluid accumulations
- Computed tomography (CT): An X-ray examination that provides detailed cross-sectional images of the inside of the body.
Blood test
The blood values provide information about the condition and function of organs. Among other things, we determine:
- White and red blood cells
- Coagulation parameters, e.g. Quick value, fibrinogen, thrombocytes
- Electrolytes
- Lactate
- Blood gases: oxygen, carbon dioxide
- Blood group, if a blood transfusion is necessary
Polytrauma: prevention, early detection, prognosis
No special measures for the prevention and early detection of polytrauma are known. However, the most common causes of polytrauma are accidents, for example in traffic, at home, at work or during sport. Disputes and physical altercations can also cause polytrauma. To a certain extent, you can prevent polytrauma yourself by taking appropriate measures. Some tips:
- Behave defensively on the road, not aggressively – do not insist on your rights and do not provoke accidents. This applies to all road users such as car, truck, motorcycle, scooter or bicycle drivers.
- If you are driving a vehicle: do not allow yourself to be distracted and focus your concentration and attention on the road. Do not write or read any messages, push notifications or emails on your smartphone – even if you are stuck in a traffic jam.
- Make sure you have sufficient protective and warning equipment when you are out and about on two wheels.
- If you work at heights at home or at work: Take adequate protective measures. For example, make sure that ladders and scaffolding are secure and move at greater heights in a controlled and careful manner.
- They should also make sure they have good protective equipment when doing sports, such as boxing, ice hockey or climbing.
- Don’t get involved in fights and fisticuffs – it’s better to avoid people who can cause trouble. Here too, defensive behavior is better than confrontation.
Course and prognosis of polytrauma
The course and prognosis of a polytrauma cannot be generally predicted. A polytrauma means that either one injury alone or several injuries together are life-threatening. The prognosis depends on various factors, for example:
- Type (injury pattern) and severity of the injuries – it is important which and how many organs and structures are affected.
- Time elapsed until the treatment has started
- Age
- Existing underlying diseases
- Accident mechanism – blunt or open injury
Sometimes we can still save severely injured patients if we start treatment quickly and manage to stabilize the patient. However, polytrauma is sometimes (around 10 to 15 percent of cases) so severe that it is fatal.
Polytrauma: treatment in several steps
Treatment for a polytrauma must begin quickly in order to save the life of the seriously injured person. Emergency doctors therefore begin treatment at the scene of the accident, even if the nature and extent of the injuries are still unknown. Emergency doctors always try to stabilize the seriously injured person and make them fit for transport. The most important steps in emergency care are
- Ensure vital functions: Respiration, pulse, blood pressure, body temperature, oxygen saturation in the blood.
- Secure the airway: This is usually done with the help of intubation, in which we insert a breathing tube into the airway.
- Ventilation: The injured person is ventilated in order to supply the organs and tissues with sufficient oxygen.
- With the help of volume therapy, we try to compensate for a lack of volume due to large blood losses. They usually administer electrolytes as an infusion.
- Accident victims receive painkillers.
- We stop bleeding with the help of compression bandages.