Lupine Publishers | Primary-Simultane Operation Pri Politrauma
The author examines the current problems of modern medicine
associated with the growth of injuries. In recent decades, not only
has the number of injuries increased, but so does the severity of the
damage. There were many problems, both in the organization
of treatment of victims, and in the methods of surgical correction of
injuries, especially if they are combined - multiple, and at the
same time injured up to a dozen or even more persons. This is most often
the case in road traffic accidents, and they sometimes
occur on sections of highways, away from the regional and regional
centers, where the main medical staff are concentrated, and in
rural areas, where hospitals operate with very limited medical staff.
For example, the staffing of the CRB usually provides surgical
and trauma departments for 40-60 beds, that is, assistance is planned.
or a surgeon, or a traumatologists, but often come persons
with trauma of those organs and systems that are to be treated by a
neurosurgeon, angiosurgeon and other specialists. The difficulty
lies not only in the absence of them, but also in the tools for such
operations. One doctor of the CRB receives a load, which in the
regional center is allowed 5-10 or more specialists of surgical profile.
In this situation, doctors of rural hospitals should have the
technique to perform surgery in any form of trauma, but for this they
must pass the school of training in leading surgical centers,
and now they are mostly former students who know everything, but nothing
they know how to do it. Admittedly, the increase in
fatalities from injuries is partly due to this factor. The author gives
an instructive observation of polytrauma, which fits into the
context of the problem at hand.
Keywords: Polytrauma; Surgical treatment; Treatment
The Aim of the Study
To show the importance of the surgeon’s training in providing
emergency care to victims of polytrauma
Introduction
Currently, there is a widespread increase in injuries, which
is due to the rapid mechanization of work and recreation of the
person. With the increase in injuries, there were many problems
in the organization of treatment of victims with different types of
injuries. The role of peripheral treatment facilities (mainly CRB)
in providing effective assistance to traumatized persons has also
increased, taking into account the mass migration of the population
during the warmer months from cities to villages [1]. The structure
of injuries has also changed significantly - the number of combined,
multiple and combined multiple injuries is increasing. At the same
time, the combined injury includes damage to different systems,
and to multiple - the same [2]. With the one-time increase in the
number of injured organs and systems, attitudes on surgical
aggression have changed, and this has been greatly facilitated
by recent advances in anesthesiology, allowing the most severe
and pro-longed operations [3,4]. Although until very recently it
was thought that expanding the volume of surgery on the human
body is dangerous for his life [5,6]. However, the healing process
of victims with polytrauma, dictates the need not only to own,
but also to perform complex simulative manipulations on various
organs and systems. In primary osteosynthesis performed in a
combined injury, poor treatment results are twice as common as
in other methods of cross-section, and the consolidation of the
fracture occurs on average 1 month faster [7-9]. X-ray diagnosis is
also needed to clarify the nature and type of injury, but it increases
the radial effects on humans [10]. For this reason, it is necessary to
resort to magnetic resonance imaging (MRI), as well as to be able to
perform ancillary manipulations, including laparocenteza, in case
of suspected abdominal injuries [11,12]. However, the leading role
in the diagnosis of all injuries still belongs to clinical methods of
examination, and they future doctors master during their studies
at the university. On this basis, it is necessary to strengthen control
over the quality of training of future health professionals in order
to eliminate the appearance of ballast, which only interferes with the
goal - reducing fatality from injuries, if in reducing their number
they are powerless, for it is a national problem.
Material and Methods
In one of the district hospitals of Krasnodar region observed
59 victims with combined-multiple trauma, of which 41 (69%)
were affected. primary simulates were performed (from 2 to 6).
The rest had 18 (31%) Victims and this was due to their extremely
severe condition, or because of the fracture of the bones of the
base of the skull, or because of a closed heart injury, limited only
to conservative methods of treatment - skeletal stretching, skeletal
hanging of the lower limb. All of these patients died five to 18
hours after hospitalization. All patients (41) who had surgery, had
multiple fractures of tubular bones, 32 - traumatic brain injury, 6
- closed rupture of abdominal organs, 3 - a fracture of the spine,
3 - pelvic bones, 12 - ribs, 10 – bones. A total of 204 organs and
tissues were injured, ranging from 2 to 8 in one person. At the time
of hospitalization, everyone had a second- to third-degree shock.
The patients were between 13 and 52 years old. The diagnosis was
based on clinical, X-ray, endoscopic, instrumental and laboratory
examination. All of these patients had metal osteosynthesis of
tubular bones (from 2 to 5, only 86), 4 - removed spleen, 2 -
stitches on the liver, 6 - trepanation of the skull, etc. Of the 41
victims, 19 had simulated operations carried out 2-6 hours after
hospitalization, and the rest within 1 day. The duration of surgical
aggression ranged from 2 to 6 hours. Operations were performed
under general end tracheal anesthesia with the use of controlled
breathing hardware. Two traumatologists took part in the surgical
intervention with or without the involvement of a surgeon. The
23-year-old man was admitted after a road accident in a state
of extreme severity - pulse filamentous, AD - is not determined,
breathing superficial 6-8 in 1 minute. On examination - on the face
a lot of abrasions, a parting squint, pupils slightly enlarged and
sluggishly react to light, in the left temporal area of the hematoma,
from the left ear canal released a blood-bracing liquor (on the
X-ray revealed a fracture of the temporal bones). The victim has a
closed fracture of both forearms and lower third of the left thigh,
and an open middle third of both shins and the middle third of
the right thigh. The man was intoxicated. The trachea intubation
was carried out and superficial anesthesia was carried out against
the background of hardware breathing. After 6-8 hours, the blood
pressure rose to 100/50 mm hg. pillar, but soon began to fall, and
the stomach to increase in volume. Performed laparocenteza, which
revealed blood in the abdominal cavity. Suspected two-moment
rupture of the spleen and on vital signs performed laparotomy,
which confirmed the diagnosis. A splenectomy was performed, and
simultaneous operations were performed on the bone and joint
system with the involvement of two more hospital traumatologists,
i.e. two teams of specialists worked simultaneously. Sustained
metorosemetalostheism of both tibia bones and on Rush of both
femurs was performed. The simultaneous surgical creativity lasted
about 6 hours, with 5 operations performed. Closed reposition
of fragments of both forearms with plaster bandage. The general
superficial anesthesia lasted about 2 days, and all this time the
hardware breath was carried out. The hospital treatment lasted
almost 3 months. There were no complications after the surgery.
Gradually, all the fractures consolidated. However, he could not
walk without crutches because of pain in his left hip joint. The
resulting radiation load did not allow X-rays of this joint, and it was
sent to the regional center for MRI. Magnetic resonance imaging
unexpectedly revealed an old medial fracture of the cervix of the
hip, which was the cause of pain and dysfunction of this joint. All
previously diagnosed fractures have been consolidated. He refused
hip neck surgery. For 1 year he was disabled in the 2nd group.
Further communication with him was lost.
The Result
All the victims safely underwent surgery, but 2 (4.8%) after 3-5
days developed a fat embolism of the cerebral vessels, from which
they died. Thus, out of 59 patients with polytrauma, only 20 (33.9%)
died. Thirty-nine survivors had no early post-operative surgery.
The duration of inpatient treatment in them on average was 45
days (36 to 90 days). The duration of incapacity in 5 patients was
6 months, 21 - 8 months, 10 - more than a year. 3 (7.7%) patients
had a persistent disability - 2 it was caused by the consequences of
a severe traumatic brain injury, and 1 - a false joint of the cervix of
the hip.
Discussion
Thus, the performance of primary Simultane operations in
combined-multiple trauma is practically and economically justified
activity. They make it possible to successfully combat shock by
creating stability of fragments and early activation of victims.
The very method of operation, which allows to use existing metal
structures effectively, is of great importance in the outcome of the
operation. The materials presented in the article fully confirm the
data of the literature that these operations reduce the number of
postoperative complications by 2 times; on average for 1 month
accelerate the consolidation of breaks, which accelerates the
rehabilitation of victims. The cause of failure sits largely depends
on the severity of the brain and heart injury, and this problem is
now waiting to be solved.
Conclusion
Primary simultane operations in combined-multiple trauma
can be attributed to the achievements of modern medicine. They
allow doctors in polytrauma to actively influence the correction of
homeostasis disorders and accelerate the consolidation of bone
fractures, which has a clear economic effect. The introduction
of new surgical technologies will lead to further progress in the
treatment of polytrauma.
