多重創傷

多重創傷涉及多個身體系統損傷,需系統性評估及優先處理威脅生命的問題。遵循ABCDE原則進行初步穩定。

Polytrauma injures two or more body systems simultaneously, so the insults summate instead of acting in isolation. Haemorrhage and third-space loss cut preload and oxygen delivery; anaerobic metabolism raises lactate and drives a metabolic acidosis. Blood loss, cold fluids and prolonged exposure add hypothermia, and hypothermia plus acidosis plus dilution and consumption of clotting factors and platelets complete the lethal triad — acute traumatic coagulopathy, in which bleeding no longer stops mechanically. Blunt thoracic impact superimposes pulmonary contusion, pneumothorax and myocardial contusion, worsening hypoxaemia exactly when oxygen demand peaks, while head injury adds raised intracranial pressure for which hypotension and hypoxaemia are the two drivers of secondary brain injury. Ischaemia-reperfusion and released damage-associated molecular patterns then provoke a systemic inflammatory response over 24-72 hours. Occult injuries — diaphragmatic rupture, urinary tract avulsion, delayed splenic or hepatic haemorrhage — declare themselves late, which is why serial reassessment outweighs any single triage snapshot.