Patient with polytrauma is a critical patient. Such patients need to be intensively monitored to know how they are behaving.
Monitoring allows early diagnosis and early intervention in case problem arises. The monitoring could be noninvasive (in which one need not to pierce the body) or invasive.
Noninvasive Monitoring
This includes monitoring of ischemia, blood pressure, pulse oximetry (used to measure oxygenation level in blood in digits), core temperature, and heart sounds.
Capnography is used to monitor the level of carbon dioxide in the exhhaled air from lungs.
Invasive Monitoring
Urinary Output
An indwelling urinary bladder catheter is inserted in trauma victims to monitor the urinary output (the volume of urine passed in a given duration. The volume of urine output and reflects renal perfusion and guide the adequacy of fluid resuscitation in the absence of renal failure or diuretic administration.
Hematuria when present may indicate trauma to the urinary tract.
Arterial Blood Pressure
Invasive blood pressure monitoring with an arterial catheter is indicated in crtically injured patient. . An arterial catheter when present also facilitates frequent sampling of the blood to monitor the hematocrit, blood chemistries, and coagulation status.
Central Venous Pressure
A CVP catheter monitors the right heart filling pressure which is taken as a measure of the circulating volume status and the adequacy of resuscitation in the patient without significant cardiac disease. When present this also provides access to the central circulation for the administration of medications.
Intracranial Pressure
The goal here is to prevent secondary neurological injury with early recognition and early management of the insult. Ventricular catheters, may be placed for suspected severe head injuries with elevated intracranial pressure.
These also permit calculation of the cerebral perfusion pressure, and optimization of intracranial dynamics to ensure adequate perfusion and prevent secondary neurologic injury.
Electroencephalography, evoked potentials, or transcranial Doppler ultrasound may also be used in selected cases.
Coagulation Profile
The coagulation status of the trauma patient must be monitored frequently during severe, ongoing blood loss with transfusion of blood products. Prothrombin time, PTT, platelets, fibrin degradation products, and fibrinogen should be done whenever necessary.
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