Polytrauma Management and Links to EMS.

Background: Multiple injuries are the second leading cause of morbidity, invalidity and mortality in developed and developing countries in children, young people and the elderly. The most frequent causes are: road traffic accidents, falling from heights, firearms, vehicles, colds and explosive devices. The incidence and prevalence of polytrauma differs from region to region and the largest number of deaths from multiple injuries or polytraumatis occur within the first trauma time, often defined as the "golden hour of trauma". Aim: Provide medical care at all stages of managing the injured with politrauma with basic and advanced support in order to reduce: morbidity, disability and mortality. Materials and methods: The research material was obtained from UCCK Emergency Clinic archive. The research is retrospective, descriptive, qualitative, for the period January-December 2018 In the research only injured with: injuries, sex, type of pathologies, causes, road traffic, firearms, cold vehicles, tools explosives as well as crashes. Results: In 42.16% or 78 cases, problems were also reported in Phase VI because no department was willing to take responsibility for accepting the injured, but was obliged for the injured to stay in the emergency department for several days without any active treatment. Discussion and Conclusions: This research highlights the limitations in the various steps of managing the injured with politrauma and the absence, delays in specialties in standard procedures of operational interventions to manage these injuries. All medical care professionals should be the primary and secondary tertiary and tertiary education and training of emergency medical staff with continuous trending, communication, RKP BLS - AED & PATLS, ALS, ATLS, ACLS and the creation of the national trauma center.

Young–Burgess classification: Inter-observer and inter-method agreement between pelvic radiograph and computed tomography in emergency polytrauma management

Background: While there are intrinsic differences in the pros and cons between plain radiographs and computer tomography, the role of pelvic radiographs in polytrauma management is diminishing as computer tomography scans are becoming more accessible. Previous studies found varying results in the inter-observer agreement in pelvic radiograph interpretations. Objectives: To evaluate inter-observer agreement of classifying pelvic fractures in major trauma patients by emergency physicians, and the inter-method agreement between plain radiographs and computer tomography scans. Methods: Three hundred sixty-nine patients with pelvic trauma were recruited from the trauma registries of four designated trauma centres in Hong Kong, each having one set of anteroposterior pelvic radiographs and pelvic computer tomography scans. Pelvic radiographs were classified by two emergency physicians using Young–Burgess classification, and pelvic computer tomography scans classified by an experienced radiologist. Disagreed pelvic radiographs were evaluated by a senior emergency physician to make a final decision before comparing with computer tomography scans. Cohen’s kappa was used to measure the inter-observer and the inter-method agreements, in the groups ‘mechanism of injury’, ‘stable versus unstable fractures’ and ‘complete classification’. Results: Inter-observer agreements of plain radiograph classification for ‘mechanism of injury’, ‘stable versus unstable fractures’ and ‘complete classification’ were moderate to substantial (κ = 0.72, 0.60 and 0.55, respectively). Inter-method agreement for the three groups between plain radiographs and computer tomography were fair to moderate (κ = 0.42, 0.59 and 0.38, respectively). Conclusion: The inter-method agreement between plain pelvic radiographs and computer tomography scans was fair in classifying pelvic fractures, and moderate in detection of unstable pelvic fractures. If the patient is haemodynamically unstable or when computer tomography is unavailable, it is reasonable to obtain plain radiographs to screen for unstable pelvic fractures to expedite early intervention. A review in the education approach and material of Young–Burgess classification may improve inter-observer agreement.

Military burns

Military burns can be accidental or due to combat and are generated by a wide variety of mechanisms including explosives (main), incendiary, chemical and nuclear weapons. Explosives give rise to a blast wave or a blast wind which cause primary (eg. barotrauma) to quaternary (eg. burn) effects on multiple organs. Blast injury secondary effects (penetrating injuries) are the leading cause of death in military attacks. Infection associated mortality occurs at higher rates in combat burns. Polytrauma management follows ATLS/EMSB guidelines. Outcomes are similar to civilians but can lead to long term physical and psychological morbidity. Prevention is via pre-deployment education and protective equipment.