Trauma Series: POLYTRAUMA Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT The field of medicine is rapidly advancing, which means that we can save many people who once would have been lost to serious injury. However, these advances have created an influx of polytraumatic patients — patients with two or more acutely serious injuries, at least one of which is life threatening. Medical staff needs to be prepared to meet the unique needs of these patients, from the field to the emergency room and in both acute and post-acute care situations. Additionally, it is absolutely vital that medical professionals understand the psychological needs of polytrauma patients so they can help them achieve healing of both body and mind. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Initial stabilization of the polytrauma patient requires well-prepared teams to ensure life is saved. Patients with polytrauma show a high prevalence of post trauma biopsychosocial symptoms. Nurses are essential members of the trauma and critical care health teams. Educating nurses to provide competent early trauma and follow-up care is an essential requirement that significantly reduces morbidity/mortality, and improves quality of life, for polytrauma victims. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Course Purpose This course will provide advanced learning for nurses interested in the management of the individual with polytrauma. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 3/1/2016 Termination Date: 8/10/2016 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Which of the following statements is/are true of polytrauma: a. Polytrauma is the leading cause of death globally. b. The death rate is highest in individuals under the age of 44. c. Trauma is the leading cause of death in individuals under the age of 35. d. All of the above. 2. The most common cause of military polytrauma is: a. from gunshot wounds. b. caused by chemical weapons. c. caused by explosive devices or blasts. d. vehicular accidents. 3. True or False: Polytrauma in a patient differs from general, multiple injuries in a patient, in that with polytrauma injuries at least one of the injuries is life threatening. a. True. b. False. 4. During the initial stage of contact with a person suspected of having a traumatic brain injury, medical personnel should: a. ensure that the patient has a proper supply of oxygen to the brain and the rest of the body. b. maintain an adequate blood flow while controlling blood pressure. c. assess the patient and determine the extent of the injury. d. Answers a., and b. 5. When burns occur on the face or neck: a. the patient will require surgical procedures. b. the patient will require breathing assistance. c. the patient will require cutting the eschar in several places. d. the patient will require skin grafts. 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Due to advances in the field of medicine, many individuals who would have once been lost to serious injury can now be saved. As a result, the number of polytrauma patients – those with two or more acutely serious injuries, one of which is life threatening – has increased. Polytrauma is complex and requires medical personnel with advanced knowledge of emergency treatment and management.1 Medical personnel must be prepared to meet the unique needs of these patients, from the field to the emergency room and in both acute and post-acute care situations. Additionally, it is absolutely vital that medical professionals understand the psychological needs of polytraumatic patients so they can help them achieve healing of both body and mind. Polytrauma occurs as the result of accidents or during military combat. In either instance, the treatment must be tailored to meet the specific needs of the patient. In combat situations, polytrauma is caused primarily by blast related trauma, while civilian trauma can be caused by a number of incidents including motor vehicle accidents, bicycle accidents, firearms, industrial accidents and any other accidents that have the potential to cause severe injuries. Polytrauma is complex and requires a diverse range of services to best meet the needs of the individual patient. Polytrauma care providers must be able to provide initial care that is focused on patient stabilization, while also working to address any secondary issues that are caused by the trauma.2 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Definition And Incidence Polytrauma involves multiple injuries, which are typically complex. At least one of the injuries is life-threatening and requires immediate care. Polytrauma often has long lasting effects on the patient and can result in physical, cognitive, psychological or psychosocial impairments and disability. Polytrauma differs from general multiple injuries in a patient, as these are often not severe or life threatening; and, is also different from a single, severe, life threatening injury.3 Ultimately, what distinguishes polytrauma from other injuries is that it is specifically defined as multiple, complex injuries of which at least one is life threatening. Polytrauma is primarily caused by critical accidents and is especially prominent in the military population as a result of combat. The following is a list of the common causes of polytrauma: Type of Accident: Road traffic accidents Industrial accidents Sport accidents Accidents in leisure time Accidents in the home Violent crimes Burials Suicide attempts Catastrophes Effects of war Accidents caused by internal conditions (i.e., heart attack) 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Mechanism of accident:4 Deceleration trauma Fall trauma Trauma resulting from being run over Crush trauma Avulsion trauma Penetrating injury Explosion injury Thermal injury Chemical injury Radiation injury Polytrauma is the leading cause of death globally. The death rate is highest in individuals under the age of 44, with trauma being the leading cause of death in individuals under the age of 35. In the United States, blunt trauma caused by motor vehicle accidents and falls is the primary cause of death in polytrauma victims. In combat situations, polytrauma is usually the result of explosive devices and contact with flying shrapnel or gunshots. Polytrauma is also the leading cause of disability in individuals between the ages of 15 – 24.5 According to the World Health Organization (WHO), the following incidents accounted for the majority of non-combat polytrauma:6 Road Traffic Accidents – 24.3 million Falls – 37.3 million Violence – 17.2 million Fires – 10.9 million In the civilian population, polytrauma is very complex and impacts patients differently depending on the