Acute Care Management of a Patient with Multiple Trauma
Original Editor - User Name
Top Contributors - Ewa Jaraczewska and Jess Bell
Introduction[edit | edit source]
Early acute care rehabilitation initiated on the Intensive Care Unit has a positive effect on patient's functional status, muscle strength, mechanical ventilation duration, walking ability at discharge, and health quality of life.[1]Patients with multiple trauma must often overcome the effects of the use of mechanical ventilation, administration of drugs, sedatives, analgesics, and drugs to control their anxiety and agitation. [1]The secondary complications may include joint contractures, thromboembolism, pressure ulcers, pneumonia, difficulties with weaning off the ventilator, delirium, and development of disabilities. [1]There is a social impact of a prolonged hospitalisation with increased days without income, inability to provide for family and inability to fulfill previously established social roles. This article provides an overview of the multiple systems assessment of a patient with a complex injury during an acute care hospitalisation.
Multiple Trauma[edit | edit source]
"Major trauma refers to physical injury or a combination of injuries where there is a strong possibility of death or disability and is commonly defined using an Injury Severity Score."[2]
The Injury Severity Score allows to describe severity of injury in a trauma patient. It includes the assessment of 6 body systems that receive scores according the Abbreviated Injury Scale. A score greater that 15 defines major trauma. [3]
Interdisciplinary Team Approach[edit | edit source]
Patients with complex orthopaedic trauma admitted to the hospital benefit from early rehabilitation interventions to prevent complications and promote recovery. Acute care trauma team and rehabilitation team form an interdisciplinary team when the team members work together in treatment and goal setting. The optimal approach for the management of a patient with complex orthopaedic trauma requires clinical collaboration between the members of the interdisciplinary team to ensure successful integration of medical, rehabilitative, psychosocial, and financial resources available across various specialties. The care of the patient with multiple orthopaedic injuries often necessitates the involvement of the orthopaedic surgeon, nursing staff, physiotherapist, occupational therapist, respiratory therapist, speech-language pathologist, and social worker.
Physiotherapy Assessment[edit | edit source]
Before initiating the assessment, physiotherapist must obtain information that will help to determine patient's appropriateness for physiotherapy intervention. This is completed via chart review, discussion with the members of the team and patient's interview.
Chart Review[edit | edit source]
The patient's chart should provide the following information:
- Movement precautions and weight-bearing restrictions
- Plan to manage fractures to determine patient's functional mobility progression
- Patients at a high risk of complications receive early temporary stabilisation followed by delayed definitive fixation[4]
- Information on medical stability
- Ventilator settings and plans for extubation
- Additional complications
- Lab values and vitals
- Haematocrit
- Haemoglobin
- Markers for acute infection:C-reactive protein (CRP) and procalcitonin (PCT)[5]
- Vitals
- Blood pressure, heart rate and rhythm, temperature, and respiratory rate
- Trend in arterial blood gases (ABG)
- pH, pCO2, pO2, bicarbonate (HCO3), base excess (BE), Lactate
- Level of sedation
Discussion with Interdisciplinary Team Members[edit | edit source]
- Surgeon: Plan to manage fractures to determine patient's functional mobility progression
- Patients at a high risk of complications receive early temporary stabilisation followed by delayed definitive fixation[4]
| Intensive Care Unit | Acute Care Ward | ||
|---|---|---|---|
| Orthopaedic Surgeon |
|
||
| Nursing Staff | |||
| Physiotherapist | |||
| Occupational Therapist | |||
| Respiratory Therapist | |||
| Speech-Language Pathologist | |||
| Social Worker |
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci. 2018 Sep;30(9):1193-1201.
- ↑ Naess HL, Vikane E, Wehling EI, Skouen JS, Bell RF, Johnsen LG. Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Arch Rehabil Res Clin Transl. 2020 Jun 25;2(4):100070.
- ↑ Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit Care Med. 2019 Feb;23(2):73-77.
- ↑ 4.0 4.1 Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SP. The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries. Int J Crit Illn Inj Sci. 2017 Jan-Mar;7(1):32-37.
- ↑ Binnie A, Lage J, Dos Santos CC. How can biomarkers be used to differentiate between infection and non-infectious causes of inflammation? Evidence-Based Practice of Critical Care. 2020:319–324.e1.
