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This case report details the challenging management of a 45-year-old male construction worker who suffered severe multiple injuries after a fall and subsequent collision with cement mixers. The patient presented with extensive injuries, including amputation, fractures and internal bleeding, leading to a state known as the 'triangle of death'. Despite the initial grim prognosis, evidenced by an ISS score of 28 and a mortality risk coefficient of 89.56%, the patient was successfully resuscitated and managed through a multidisciplinary approach. This included damage control resuscitation, emergency vascular interventions and targeted temperature management for brain protection. The patient's recovery highlights the effectiveness of comprehensive trauma management and the critical role of coordinated care in severe multi-trauma cases.

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AIMS: The aim of this study was to enhance the effectiveness of an integrated treatment model for patients with severe multiple injuries in China. METHODS: In this study, we conducted a retrospective analysis of data from 110 patients with multiple severe injuries. These patients were divided into two groups based on the treatment model they received. The first group, called the MDTM group, received the integrated treatment model, which involved a multidisciplinary team-based approach. The second group, designated the TSM group, received the traditional specialist-based treatment model. The primary outcome measure was the survival rate of patients after treatment. Secondary outcomes included the time spent on hospital emergency treatment, the length of hospital stay, the mortality rate, and family satisfaction. RESULTS: The survival rate of patients after treatment in the MDTM group (83.93%) was significantly greater than that in the TSM group (70.37%). Consequently, the mortality of patients after treatment in the MDTM group (16.07%) was significantly lower than that in the TSM group (29.63%). Furthermore, the MDTM group demonstrated significantly shorter durations of rescue efforts and shorter hospital stays. Additionally, family satisfaction was significantly greater in the MDTM group. CONCLUSION: The integrated treatment model shows potential for optimizing outcomes for patients with multiple severe injuries and generating higher levels of family satisfaction. This model holds practical applicability in the context of China and may help alleviate the strained relationship between physicians and patients.

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Traumatismo Múltiple , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , China , Pueblos del Este de Asia , Tiempo de Internación/estadística & datos numéricos , Traumatismo Múltiple/terapia , Traumatismo Múltiple/mortalidad , Estudios Retrospectivos

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Background: To investigate the early application of pulmonary ultrasonography and arterial blood gas analysis in critical patients with severe multiple injuries exacerbated by respiratory failure. Patients and Methods: The retrospective selection was performed on 81 patients admitted to our critical care unit between January 2020 and January 2021 with severe multiple injuries rendered worse by respiratory failure. Based on the different examination procedures, the patients were categorised into three groups (n=27): group A; diagnosed with pulmonary ultrasonography, group B; diagnosed with arterial blood gas; and group C; diagnosed with both pulmonary ultrasonography and arterial blood gas analyses. Patients were subsequently divided into a survival group (n = 65) and a death group (n = 16). On an annual basis, patients' prognoses were examined in relation to the predictive value of pulmonary ultrasound. Results: Initial diagnosis, diagnosis, and initial correct treatment times were significantly shorter in groups B and C than group A (P<0.05). In contrast, initial diagnosis time, diagnosis time, and initial correct treatment times were potentially shorter in group C than in group B (P<0.05). Compared to groups B and C, group A had a considerably lower diagnosis rate for the examination methods (P<0.05). The right diaphragm displacement and left diaphragm displacement in the survival group were potentially higher than the LUS score (P < 0.05). In contrast, the survival group's lung ultrasound score (LUS) was considerably lower than the death group's. Statistical analysis showed that the predictive values of right diaphragm displacement, left diaphragm displacement, and mean diaphragm displacement were significant compared with the LUS score. The findings of the receiver operating characteristic curve demonstrated that the right, left, and average diaphragm displacements had high predictive values. Conclusion: In the early evaluation of patients with severe multiple injuries complicated by respiratory failure, pulmonary ultrasonography combined with arterial blood gas analysis is crucial for the rapid diagnosis and prognosis prediction of patients.

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Objective To investigate the clinical effect of the blood transfusion with equal ratio component in severe multiple in‐juries with acute traumatic coagulopathy(ATC) .Methods Thirty‐eight patients who had severe multiple injuries with ATC were divided randomly into control group and treatment group .Control group was treated with the different ratio packed red blood cells (PRBC)and fresh frozen plasma(FFP) ,while treatment group received the equal ratio PRBC and FFP .Hemoglobin(HB) ,pro‐thrombin time(PT) ,international normalized ratio(INR) ,fibrinogen(FIB)were measured on the 1st ,2nd ,3rd day after admission . The total amount of PRBC during these 3 days ,the days of hospitalization in ICU ,the corrected rate of shock ,the 28‐day mortality were compared between groups .Results Compared with the control group ,the levels of PT ,INR and FIB of treatment group on the 2nd ,3rd day after admission were better(P<0 .05) .The total amount of PRBC[(18 .5 ± 6 .3)U]during these 3 days ,the days of hospitalization in ICU [(5 .9 ± 4 .3)d] in treatment group were less than those in the control group [(25 .9 ± 7 .8)U ,(10 .5 ± 7 .6)d] (P<0 .05) ,while the corrected rate of shock(85 .0% )in treatment group was higher than that of the control group(44 .4% ) .The 28‐day mortality(10 .0% )in treatment group was lower than that of the control group(27 .8% )(P<0 .05) .Conclusion The blood transfusion with equal ratio component in severe multiple injuries with ATC could not only improve blood clotting index ,reduce the total amount of PRBC and the time in ICU ,but also increase the corrected rate of shock and decrease the 28‐day mortality .

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Objective To explore the strategies of diagnosis and treatment of severe multiple injuries in Emergency Intensive Care Unit (EICU).Methods The clinical data of 226 patients with severe multiple injuries were analyzed retrospectively.188 patients were treated by surgical operation,and 38 patients were not treated by surgical operation.Results Among these patients,46 patients (accounted for 20.3%)were with pulmonary infection and atelectasis,41 patients (accounting for 18.1%)were with multiple -organ dysfunction syndrome (MODS), 35 patients (accounted for 15.5%)were with acute respiratory distress syndrome (ARDS),and 19 patients (accounted for 8.4%)were with stress ulceration and bleeding.198 patients (accounted for 87.6%)were successfully rescued, and 28 patients (accounted for 12.3%)died.The main cause of death in the early stage was the serious craniocerebral injury,and the main cause of death in the later stage was the multiple -organ dysfunction.Conclusion EICU plays a very important role in comprehensive treatment of severe multiple injuries,and can obviously increase the success rate of treatment and cure of severe multiple injuries.