Prise en charge du polytraumatisé au cours des vingt-quatre premières heures

Abstract

Multiple trauma can be defined as a violent trauma that may be responsible for multiple traumatic lesions likely to be life-threatening and/or induce definite impairment. Pre-hospital resuscitation includes immobilization, initial assessment and treatment of respiratory and circulatory distresses. Upon arrival at the hospital, an invasive arterial pressure catheter should be placed. Measurement of hemoglobin, haemostasis, and arterial blood gases are mandatory. The initial assessment includes chest X-ray, abdominal echography, and pelvic X-ray, enabling to take the following appropriate emergency decisions: chest drainage, laparotomy, and arterial embolization. Then complete spine X-ray assessment should be carried-out as well as head CT-scan and contrast-enhanced thoracic, abdominal, and pelvic CT scan. A complete clinical re-assessment is mandatory during the tertiary survey. Indications for imaging and surgery should always take into account the risk/benefit balance. The behavior of the trauma team should be educated. Multiple trauma patients should be admitted in those fully equipped trauma centers that have strong experience of such management.