J Community Health 9:91–109, Harris I, Dao ATT, Young J et al (2007) Factors predicting patient satisfaction following major trauma. Google Scholar, Liener UC, Rapp U, Lampl L et al (2004) Inzidenz schwerer Verletzungen – Ergebnisse einer populationsbezogenen Untersuchung. This condition is in contrast to isolated trauma injury where there is a single injury encountered. – 2.5 mg/dL to 4.0 mg/dL---6.4% Mortality Sie haben Einfluss auf die Lebensqualität und sind noch viele Jahre nach dem Unfallereignis messbar. Contamination: open fractures must always be considered as contaminated. Epidemiology OEF/OIF/OND veterans have a high polytrauma rate. © 2023 Springer Nature Switzerland AG. Im Polytrauma-Computertomogramm zeigen sich keine relevanten Verletzungen. - Treated with 1.5 litres of Ringer lactate or 1 litre of World J Emerg Surg. Injury 31:751–756, MacKenzie EJ, Siegel JH, Shapiro S et al (1988) Functional recovery and medical costs of trauma: an analysis by type and severity of trauma. The CRASH-2 trial demonstrated that tranexamic acid, an antifibrinolytic drug with a good safety profile, administered within 3 hours of either blunt or pen etrating trauma, significantly reduces transfusion requirements and mortality. Theor Surg 6:138–142, Pirente N, Gregor A, Bouillon B, Neugebauer E (2001) Lebensqualität schwerstverletzter Patienten ein Jahr nach dem Trauma. response (SIRS) Incidence of Acute surgery • Heart and major vessel EXTREME Close to death uncontrollable The ETC strategy was widely used but several reports in the literature described adverse outcome after ETC in some groups of patients with an increased incidence of ARDS and multiple organ failure. resuscitation Non-contrast CT is required in the assessment of hyperacute traumatic brain injuries 5. Early whole-body (trauma) CT (WBCT) allows identification of the source of hemorrhage and targeted surgery or interventional radiology to stop the bleeding. • Massive internal or external hemorrhage, BREATHING 1/29/2017 16, – Air way maintenance with control of cervical The origin of DCR comes from the military′s experience of management of major hemorrhage during recent conflicts in Afghanistan and Iraq. Department of Health & Family Welfare, Government of West Bengal, Principles of Management of the multiply injured patient, Trauma management in_primary_care_setting, Trauma Management in Primary Care Setting, Pathology and management of compartment syndrome in orthopedics 1, Surgery 6th year, Tutorial (Dr. Aram Baram), Early Appropriate care in Orthopedics.pptx, ANTERIOR TIBIAL SYNDROME AND REYNAUD''S DISEASE, ENT Disorders_Bacterial Tonsillitis Presentation.pptx, ALCOHOL WITHDRAWAL SYNDROME. JavaScript is disabled. Inj Prev. A precise definition of polytrauma is important for quality management. Der Anspruch an einen optimalen Rehabilitationsprozess stellt hohe Anforderungen an die Rehabilitationseinrichtungen und an das Rehabilitationsteam, die letztendlich nur von spezialisierten Einrichtungen erfüllt werden können. Ursachen Ein Polytrauma ist die Folge einer Gewalteinwirkung. http://www3.ndr.de/sendungen/visite/archiv/haut_haar_zaehne/gesicht108.html, http://de.wikipedia.org/wiki/Organisches_Psychosyndrom. • Orthopaedic surgeon will reaming further increase the incidence of To access the videos, please follow the URL link. • Major blood vessel tear Thromboelastography and fibrinogen levels together with standard coagulation tests may be used to guide the administration of additional fibrinogen concentrate or cryoprecipitate. patients with spinal injury, maintain spinal precautions Stawicki S. Trends in Nonoperative Management of Traumatic Injuries – A Synopsis. • Pelvic bleeding Injury 27:133–138, Ott R, Holzer U, Spitzenpfeil E et al (1996) Lebensqualität nach überlebter Schwerstverletzung. Am J Epidemiol 152:633–639, Lee DJ, Gomez-Marin O, Lam BL et al (2005) Visual impairment and morbidity in community-residing adults: The national health interview survey 1986-1996. Wir verwenden notwendige cookies , damit diese Website funktioniert, und optionale Cookies, um Ihr Erlebnis zu verbessern. The first clinical priority is to stop hemorrhage, prevent hypoxia and hypercarbia (which result in acidosis), and avoid hypothermia. response brought Graham R. Battlefield Radiology. J Trauma 42:919–926, Holbrook TL, Anderson JP, Sieber WJ et al (1998) Outcome of major trauma: discharge and 6-month follow-up results from the Trauma Recovery Project. Trauma. Although hemorrhage has remained a primary cause of morbidity and mortality in acute trauma, emerging strategies that can be applied pre-medical facility as well as in-hospital have continued to improve care. • Pelvis X-Ray is mandatory in polytrauma patient • High spinal cord – U : Unresponsiveness' to all stimuli, Normal – 15/15 Das Polytrauma stellt die führende Todesursache bei Patienten unter 44 Jahren dar. The ‘natural’ systemic Subsequently, the advent of antibiotics together with advances in intensive care and anesthesia, implant design, and the implementation of standardized fracture fixation techniques by the AO supported a more operative approach for fracture fixation. Complications: K.PRAKASAM • Often high in 1st few hours but will drop if resuscitation is Fat Embolism . • Pneumonia, bedsore, renal failure, inadequate is confirmed by Clinical finding, 2. Materials and methods: • Allows clot formation - 35.198.23.75. 16. response (SIRS) – C-Spine lateral, Chest X Ray, Pelvic film (trauma series) • Hypercapnea response UNSTABLE Remain hemodynamically This review investigated the effect of these changes on global all-cause and cause-specific mortality in polytrauma patients admitted to the intensive care unit (ICU). • If preventive measures are taken, 70% deaths can be J Trauma 30:480–483, Regel G, Seekamp A, Takacs S et al (1993) Rehabilitation und Reintegration polytraumatisierter Patienten. Portable coagulometers and thromboelastometry allow “point of care” testing in the trauma room, critical care, or operating room and provide real-time data on coagulopathy to guide patient management. decreased mental status,negligible urine output. Polytrauma or multiple trauma has been defined as a pattern of potentially life-threatening injuries involving at least two body regions. An exaggerated SIRS might lead to ARDS, multiple organ dysfunction syndrome (MODS), or even death while a decompensated CARS could contribute to immunosuppression and development of early sepsis [9]. Lately, the concept of damage-control resuscitation (DCR) has been introduced in the civilian trauma setting. time Trauma is directly taken from the Greek word τραυμα (trauma) meaning 'wound' and was first recorded in English in 1693 meaning a physical wound 24,25. improvement fatal Unfallchirurg 107:483–490, Article  Part of Springer Nature. J Trauma 62:461–470, Stalp M, Koch C, Ruchholtz S et al (2002) Standardized outcome evaluation after blunt multiple injuries by scoring systems: a clinical follow-up investigation 2 years after injury. limbs The survival chances of multiple trauma patients have improved continuously over the last decades. Early variables of clot firmness assessed by viscoelastic testing have been reported to be good predictors for the requirement for massive transfusion and for mortality in trauma patients [18]. Bieler D, Kollig E, Hackenberg L et al. • Urologist Alexander L, Hanna T, LeGout J et al. HOARSENESS. musculoskeletal injury Initial Assessment and Treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) Approach. • Hypoventilation Soc Sci Med 31:743–751, Scheibler F, Janßen C, Pfaff H (1997) Shared decision making: ein Überblicksartikel über die internationale Forschungsliteratur. surgery or ITU, Initial lactate: The radiological report should include the following: Management and prognosis depend entirely on the type and extent of the specific injury and the complications associated with it 1. Ophthalmic Epidemiol 12:13–17, Vles WJ, Steyerberg EW, Essink-Bot ML et al (2005) Prevalence and determinants of disabilities and return to work after major trauma. Principles of care in the polytraumatized patient have continued to evolve with advancements in technology. 12. • X-RAY SIGNS OF AIRWAY Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. attention and immediate transport to the hospital and Knowing which parameters can influence trauma after effects is essential for the planning, organization, and implementation of a rehabilitation programme following severe injury. 2nd Hit: the surgery 2017;7(1):38. – Removal of dead issue Surg Clin North Am. 2 External fixator ficits after pediatric polytrauma involve injuries to the central ner-vous and musculoskeletal systems. Trauma Berufskrankh 10 (Suppl 1):99–106, Lippert-Grüner M, Mägele M, Haverkamp H et al (2007) Health-related quality of live during the first year after the severe brain trauma with and without polytrauma. Unfallchirurg 109:628–639, Mahler H, Kulik J (1990) Preferences for health care involvement, perceived control and surgical recovery: a prospective study. Radiographics. Semin Musculoskelet Radiol. Damage control This adhesion process is mediated by the expression of adhesion molecules and is vital for the subsequent extravasation of PMN leukocytes. including Glasgow Coma Score. Arch Surg 139:983–987, MacKenzie EJ, Shapiro S, Smith R (1987) Factors influencing return to work following traumatic injury. Early total care and DCO became a hot topic of discussion between European and North American surgeons as to which multiple-injured patient would benefit most from either surgical strategy. It has been clearly shown that early, prolonged surgical interventions (second hits) are associated with increased risk of bleeding and stressful stimuli capable of magnifying the already evolving SIRS. resulting in death, Control STABLE No life threatening injuries, Unable to process the form. completed. Phys Med Rehabil Kuror 12:146–156, Rimscha von HJ (2007) Berufsgenossenschaftliche Heilverfahren zur Schwerverletztenbetreuung. Bekanntlich stellen Spätkomplikationen nach Polytrauma ein großes Problem bei der Rehabilitation der Verletzten dar. spinal injury/ abdominal or pelvic injury. Significant correlations between adverse events and both the IL-6 level and SIRS have been observed [11]. –Sepsis • Depressed skull fractures sacral,internal pudendal, inferior gluteal, obturator. may lead to dysfunction or failure of remote nutrition, vascular abnormalities RIB RETRACTION Arch Ophthalmol 117:943–949, Ivers RQ, Norton R, Cumming RG et al (2000) Visual impairment and risk of hip fracture. pressure. The International Classification of Functioning, Disability and Health (ICF) provides a system to classify the after effects of trauma, which can be measured with the help of assessment instruments. oximeter or ABG Br J Radiol. response The WBCT should not be used as a “screening tool” based on mechanism of injury alone. At the same time the metabolic rate is reduced to minimize energy expenditure [10]. • It occurs after several The primary response to trauma involves the upregulation of several immune-physiological processes to maintain homeostasis and survival. 5. 1st Hit: the trauma Pathogenesis of trauma and/or traumatic injuries include: Causes of trauma and traumatic injuries include the following 1,2: recreational and/or sports-related injuries. For stabilization of long bones, external or internal fixation are options depending on the circumstances. • B – Breathing & Oxygenation • Bladder necrosis Die Überlebenschancen Polytraumatisierter haben sich in den letzten Jahrzehnten kontinuierlich verbessert. –Save life • Can lead to life threatening hemorrahge – 50% mortality At the beginning of the 20th century surgical stabilization of long-bone fractures in multiple-injured patients was not routinely performed. trauma patients must have regular training. inflammator Moreover, changes in trauma mechanism over time and differences between continents were analyzed. • Borderline • Cast, traction, pelvic binder, ex-fix, fatal The impact of gunshot wounds on an orthopaedic surgical service in an . death/Immediate trauma death • LIFE SALVAGE Mo Med. require blood transfusion. - 51.178.43.149. 2015;120(7):641-54. Plain radiographs can nicely demonstrate and characterize fractures in the extremities and small joints 14. DEATH: from multiorgan failure or adult • Extreme, Patients 2. Traumatic injuries are usually classified based on their location, their extent and their severity with different classification schemes for various organs and tissues. Unfallchirurg 112, 965–974 (2009). Any subsequent activation of various molecular cascades during therapeutic or diagnostic interventions, surgical procedures, and posttraumatic or postoperative complications are termed “second” or “third” hits ( Fig 4.1-2 ) [14]. Polymorphonuclear (PMN) granulocytes, monocytes, and lymphocytes are activated and elicit local molecular responses associated with vascular endothelial adhesion. • Severe head injury 6. Although ETC and DCO made a major impact on trauma care, it took several years to appreciate the fact that unstructured management of trauma patients is associated with avoidable death and disability. inflammatory • Intra-abdominal bleeding BLEEDING 2. unless they result in significant hemodynamic instability. Dead, ischemic tissue with a hypoxic zone at the margin: in unstable, displaced open fractures, especially after high-energy impact, a radical soft-tissue debridement is necessary as soon as possible to remove this source of proinflammatory mediators. Interleukin-6 (IL-6) is believed to be a useful marker for assessing these alternations of the immune system, as it has been found to have a consistent pattern of expression and plasma half-life. 3 Pelvic packing A patient in hemorrhagic shock with an unidentified source of bleeding should undergo immediate assessment of the chest, abdominal cavity, and pelvic ring, which represent the major sources of occult, acute blood loss in trauma. 2018;2-3:13-21. • Spine Cardiopulmonary resuscitation – V : Responds to vocal stimuli 1. – Decontaminate wounds and ruptured viscera Beware of the fact that cerebral auto regulation goes off It focuses on five different topics, 1. Der Begriff leitet sich so ab: „poly" bedeutet „mehrfach" und das Wort „Trauma" steht für Verletzung. Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht. • Violent force in the bone – Intra Medulary pressure • Back board (or) scoop stretcher used. However, it plays an important role in the workup of spinal cord injuries as well as musculoskeletal injuries such as joints, muscles tendons and ligaments. • Multiple bleeding sites in 40% of patients. Als Polytrauma bezeichnet man in der Medizin nach der Berliner Polytrauma-Definition das Vorliegen mindestens zweier Verletzungen mit einem AIS (Abbreviated Injury Scale) von ≥ 3 mit mindestens einer der folgenden Diagnosen: [1] Hypotension (systolischer Blutdruck ≤ 90 mmHg) Bewusstlosigkeit ( Glasgow Coma Scale ≤ 8) Scand J Rehabil Med 26:27–31, Cole DC, Mondloch MV, Hogg-Johnson S (2002) Listening to injured workers: how recovery expectations predict outcomes – a prospective study. Threshold for World J Emerg Surg. binder or external fixator. – Essential X-ray’s should not be avoided in pregnant Trauma Berufskrankh 10:228–234. • Cervical collar Four inter related stages [5] [6] [7] Respectfully, a study exhibited findings with a population of 16,590 OEF/OIF/OND veterans, in which 27.66% met the criteria for poly trauma. • Consider 2-3 units of FFP and a six pack of platelets Polytrauma. Abstract. Ferner sind es Gewaltverbrechen oder auch Suizidversuche wie Fensterstürze, die ursächlich für Mehrfachverletzungen verantwortlich sind. Crit Care Med 19:339–345, Brennemann FD, Redelmeier DA, Boulanger BR et al (1997) Longterm outcomes in blunt trauma: who goes back to work? Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study | Neurotrauma Reports No.1 cause of death amongst the This is a preview of subscription content, access via It is due to a combination of factors including: Thrombin-thrombomodulin complex generation within injured tissues, Activation of anticoagulant and fibrinolytic pathways. fixators. 1. saving procedures. Der Verlauf. Additionally, hemodilution resulting from resuscitation with high volume of crystalloids can also lead to defective coagulation [13]. Acute Pain 2:110–114, Chan AO, Medicine M, Air TM, McFarlane AC (2003) Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. • Pelvic bleeding Ischemia-reperfusion injury: prolonged hypovolemic shock and compartment syndrome related to fractures with or without vascular injuries are prone to ischemia-reperfusion injury with microvascular damage due to oxygen radicals. WHO, Geneva, Stucki G, Stier-Jarmer M, Berleth B, Gadomski M (2002) Indikationsübergreifende Frührehabilitation. • Accident and emergency medical officer applied. J Trauma 48:490–494, Mayou RA, Ehlers A, Bryant B (2002) Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Coccolini F, Kobayashi L, Kluger Y et al. Schueller G, Scaglione M, Linsenmaier U et al. response injury • Medullary channel depletion 2014;38(9):580-8. - results in increased pulse but no change in blood The rehabilitation of seriously injured patients, Der Unfallchirurg 20. trousers),Pneumatic anti shock garment Verhandlungsbericht der Deutschen Gesellschaft für Urologie, vol 35. In general terms the major aims of fracture management in the polytrauma patient are: Prevention of ischemia-reperfusion injury, Facilitate ventilation, nursing, and physiotherapy. 3. - does not cause a change in blood volume or Coagulopathy along with the presence of acidosis and hypothermia is termed the “lethal triad” and is associated with an increased mortality rate ( Fig 4.1-1 ). spleen, Liver, Kidney 600 mm of Hg. Check for errors and try again. Bekanntlich stellen Spätkomplikationen nach Polytrauma ein großes Problem bei der Rehabilitation der Verletzten dar. It allows an effective detection and characterization of life-threatening and unexpected injuries within a few minutes and can shorten hospital stay 5. Am J Surg 190:30–36, Sivik TM, Delimar D (1994) Characteristics of patients who attribute chronic pain to minor injury. Durch das Setzen dieser Cookies bieten wir Ihnen verbesserte Funktionen für Ihr Surferlebnis. spine in polytraumatized patient 1.Hemorrhagic shock duo to loss blood voulme ,diagnosis based on vital sign and examination characterized by hypotention tachycardia and cold skin 2.neurogenic shock duo to spinal cord injury that causes distribution of sympathetic outflow to heart and blood vessles characterized by hpotention .bradycardia .warm skin. J Trauma 42:773–777, Article  1/29/2017 69, POLYTRAUMA those with less serious injuries. • Severe trauma can result in a life threatening inflammatory The structure of the national system in England is based on the fundamental components suggested by the Committee on Trauma of the American College of Surgeons consisting of: Leadership (at all levels of trauma care delivery), Designated and accredited trauma care facilities (major trauma centers (level I), trauma units (level II), local emergency hospitals (level III), transport services, rehabilitation units), Human resources (planning and development, administrative and clinical teamwork), Education-prevention-public awareness, good communication (at all levels of the trauma system), Audit and research with quality assurance monitoring [6]. Latest evidence suggests that the optimal ratio of blood, FFP, and platelets is 1:1:1 and this is associated with improved survival rates [19]. Dr. LANDO ELVIS.pptx, expo miguel recargada final ft mery - copia.pptx, dmandsurgeon-150628125636-lva1-app6891.pptx, #Aamil baba in pakistan #Vashikaran spell in lahore, syndrome of multiple What Causes Polytrauma? Phys Med Rehab Kuror 12:157–162, Clemens K, Hack E, Sülzer A, Schottmann J (2008) Krisenbewältigung als wichtiger Faktor des Rehabilitationsprozesses. Int J Crit Illn Inj Sci. 1/29/2017 2. management by a team of surgeons Splenic Trauma: WSES Classification and Guidelines for Adult and Pediatric Patients. • Hypothermia, Mask O2 Learn more about Institutional subscriptions, Statistisches Bundesamt, Wiesbaden (2008) Diagnosedaten der Patienten und Patientinnen in Krankenhäusern 2006. Using a scale between 1 and 6, with 1 being a minor injury, 5 representing the most severe, and 6 signifying a fatal injury, each of 9 areas of the body. Local and systemic reactions are initiated in the immediate aftermath of severe trauma. Ein Unfall mit einem Zweirad geht daher häufig mit schweren Verletzungen einher. • Stabilization of spine is mandatory. groups. Kidney and Uro-Trauma: WSES-AAST Guidelines. –Restore function Sozialmed Präventivmed 48:11–23, Lochman JE (1983) Factors related to patients‘ satisfaction with their medical care. Die Folgen waren/sind unglaublich: Epilepsie, starke kognitive Störungen (kein Rechnen mehr, Merkfähigkeit herabgesetzt, visuelle Verarbeitungsstörung), 7 OPs, Ataxie, Hemiparese und eine daraus resultierende Skoliose, versteifter Arm, Gang-und Gleichgewichtsstörungen (Schlagseite beim Laufen), Sprachstörungen, Doppelbilder, Nystagmus li. Emerg Med Clin North Am 11:241–253, Häusler JMC, Zimmermann H, Tobler B et al (2001) Die volkswirtschaftlichen Kosten von Polytrauma. Trauma Berufskrankh 8:74–79, Frommberger U, Schlickewei W, Stieglitz R-D et al (1998) Die psychischen Folgen nach Verkehrsunfällen – Teil 2: Ergebnisse einer prospektiven Studie. Infolge des medizinisch-technischen Fortschritts ist die Letalitätsrate nach Polytrauma von über 40% vor einigen Jahrzehnten mittlerweile auf unter 20% gesunken [ 4, 5, 6 ]. • ELECTRO-CARDIOGRAPHIC MONITORING Coccolini F, Montori G, Catena F et al. Detection of coagulation abnormalities with viscoelastic testing has recently been introduced. This condition is in contrast to isolated trauma injury where there is a single injury encountered. In response to these observations, the concept of damage-control orthopedics (DCO) for the management of multiple-injured patients was developed. Behav Res Ther 40:665–675, Dittmer H, Bauer F (1987) Ergebnisse der psychischen, sozialen und somatischen Rehabilitation nach Polytrauma, unter besonderer Berücksichtigung der Motorradfahrer. Unfallchirurg 104:1162–1167, Post RB, van der Sluis CK, Ten Duis HJ (2006) Return to work and quality of life in severely injured patients. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. • Massive blood loss, death / Early trauma death Following trauma, numerous adaptations in inflammatory and immunological functions occur. 2nd hit is common Minor traumatic injuries might be seen and evaluated only clinically or might need further radiographic evaluation before definitive treatment. Severe chest injury →only life If this occurs systemically, rather than at the local site of injury, PMN leukocytes lose their autoregulation and release toxic enzymes causing remote organ injury in the form of ARDS or MODS. {"url":"/signup-modal-props.json?lang=us"}, Feger J, Bell D, Anan R, et al. 1. In the setting of suspected polytrauma, it is usually acquired as a trauma-specific whole-body CT protocol 5. Fractures have an important impact on the severity of the systemic reaction to trauma due to: Hemorrhage: prolonged states of shock as well as exsanguinating hemorrhage are frequently associated with unstable pelvic ring injuries, femoral shaft fractures, multiple long-bone fractures, and open injuries. • Early fixation of major fractures – performed with right  Prevention of bed sore. Sie dürfen diese nicht ablehnen. • Tibia Key Words: pediatric, polytrauma, orthopaedics (J Pediatr Orthop 2006;26:268Y277) Methods PubMed  – > 3 Damage Control Surgery. SURVEY & RESUSCITATION 2019;39(4):1183-202. Early total care Severe head injury → only life saving procedures, WITH CHEST INJURY Constant re-evaluation In the presence of a traumatic brain injury (GCS ≤ 8), maintenance of mean arterial pressure ≥ 90 mm Hg is recommended. • Thoracic surgeon Unfallchirurg 101:878–893, Pirente N, Blum C, Wortberg S et al (2007) Quality of life after multiple trauma: the effect of early onset psychotherapy on quality of life in trauma patients. Ziel unserer Untersuchung war es festzustellen, welche urologischen Spätfolgen nach einem Polytrauma in welcher Häufigkeit auftreten. – Control bleeding • Head injury GCS<8 Google Scholar, Mason S, Wardrope J, Turpin G, Rowlands A (2002) Outcomes after injury: a comparison of workplace and nonworkplace injury. • Day 5-10: WINDOW OF OPPORTUNITY Early total care became the optimum treatment in surgery for fracture fixation and further developments in intensive care medicine reinforced early fracture fixation in patients with polytrauma. MRI can nicely depict the soft tissues, including the brain, the spinal cord, the muscles, tendons and ligaments, and the myocardium and the parenchyma of abdominal organs. • To describe the level of consciousness Notf Rett Med 7:547–553, O’Donnell ML, Creamer M, Pattison P, Atkin C (2004) Psychiatric morbidity following injury. Hospitals receiving patients with major trauma should have a massive transfusion protocol in place. prevented meaning 30% deaths are non-salvagable deaths. These will vary according to local resources but should allow immediate transfusion of group O-negative blood with rapid availability of blood (packed red blood cells), thawed fresh frozen plasma and platelets in a 1:1:1 ratio. Polytrauma has been defined as “a syndrome of multiple injuries exceeding an Injury Severity Score (ISS) of 16 with sequential systemic reactions that may lead to dysfunction or failure of remote organs and vital systems that have not been directly injured”.
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