Multisystem trauma

Trauma remains the leading cause of death in people of age 45 and younger (Mutschler and Kanz 2002). Multisystem trauma (major trauma, polytrauma) is defined as injuries to more than one body region such as head, chest, abdomen, and extremities, one or the combination of which is potentially fatal to the patient (Trentz 2000). Trauma scores to define and characterize extend, severity, and prognosis of multisystem trauma were introduced nearly 30 years ago. Some of... 

Before helical CT scarmers were available, CT in multisystem trauma was Hmited to dedicated examinations of body parts such as head, chest, or abdomen because of the long scanning time and limited body volume coverage. With the introduction of helical CT, faster scanning times made scanning larger volumes... 

Whole-body CT (WB-CT) protocols in multisystem trauma usually consist of a non-contrast enhanced head CT, which is followed by a contrast-enhanced chest and abdominal CT. For evaluation of the spine, reformations from the chest and abdomen are of diagnostic image quality if the primary colUmation was 2.5 mm or less, and dedicated scans of the spine are not obligatory (Mann et al. 2003). The cervical spine can be scanned separately with thin coUimations after the head scan, or can be included in the chest scan. The latter option has the advantage that the cervical vessels are contrast-enhanced, and vascular injuries can be ruled out from the same dataset, sparing one additional scan. 

While intravenous contrast material is undisput-edly needed in any multisystem trauma patient, the appHcation of oral contrast material is not uniformly recommended. In patients with penetrating trauma to the chest, abdomen, or pelvis, oral and rectal contrast media application increases sensitivity for the detection of hollow organ injury (Shanmuganathan et al. 2004 Sampson et ah 2006). However, installation of contrast fluids takes some time, and patients that are unable to swallow need a gastric tube before contrast material can be given. In blunt abdominal trauma, oral contrast appHcation is not imperatively necessary to rule out bowel injuries because CT without oral contrast leads... 

Despite unstable patients, the general recommendation for multisystem trauma patients is to image them as soon as possible with CT after admission. After excluding the need for immediate operation with US, CT should be performed without further delay. The... 

The patients for WB-CT imaging have to be carefully selected and separated from those not needing a full-body scan. Table 42.3 shows parameters that are indicating suspicion of multisystem trauma. If any of these parameters is present, then WB-CT should be considered, even in younger subjects. 

In patients with multisystem trauma, CT has proven to be an adequate diagnostic tool for evaluating aU critical organic traumas with a WB-CT scan, as stated above. Consequently, MSCT could be also very helpful in correctly triaging patients that have been wrongly... 

Multisystem trauma is injury to more than one body region, one or the combination of these injuries being potentially fatal. 

MDCT, the diagnostic test of choice in multisystem trauma, produces fast, accurate high-quality images. Whole-body CT in multisystem trauma generally comprises a noncontrast-enhanced head scan, which is followed by a contrast-enhanced chest and abdominal scan. 

Some of the limitations of CT scanning in multisystem trauma are difficulty in patient positioning, and artifacts produced by clothing and equipment can obscure findings. 

Severe multisystem trauma, endotoxemia, or situations in which there is a raised metabolic demand for thiamin, such as pregnancy, thyrotoxicosis, and intercurrent illness or impaired absorption (e.g., alcohol abuse or gastrointestinal disease or resection), can produce subclinical evidence of thiamin deficiency or more severe life-threatening aspects of beriberi, such as renal and/or cardiovascular failure. The elderly may be particularly at risk of subclinical thiamin deficiency. One Belgian study on patients with a mean age of 83 years reported that 40% had a raised TDP effect (>15%), in whom there was a high proportion of Alzheimer s disease, depression, cardiac failure, and falls. The diuretic furosemide was also more frequently taken by the thiamin-deficient patients. 

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