Trauma Scoring System - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes information associated with trauma scoring systems - Injury Severity Score (ISS).
The trauma scoring system is really complex. It could predict the outcome of the patient and help in triage of the trauma patients. The most critical task has to be at the top of the list. The most important, critical patient has to be at the top of the list. The most important, critical condition had to be addressed first.
The Glasgow coma scale is related to a head injury. It uses eye opening response, verbal response and motor response. A large number is good for the Glasgow coma score, which is the opposite of the injury severity score, where a large number is bad. In the Glasgow coma scale you count what is working or functional. Severe brain injury is less than 9. In the injury severity score (ISS) you count what is injured. The mortality rate correlates with the injury severity score (ISS). The higher the injury severity score (ISS) the more the mortality. If the ISS is more than 18, then this means that the patient is a multiple injury patient that probably needs to be transferred to a trauma center.
The ISS is the sum of the three most significant injuries from three separate anatomical locations. The anatomical locations are head, face, neck, thorax, abdomen/pelvis, spine, upper extremity, lower extremity, and external. Every injury has a grade. Grade 0 is no injury, grade 1 is a minor injury, grade 2 is a moderate injury, grade 3 is a severe injury (not life threatening), grade 4 is a severe injury (life threatening), grade 5 is a severe injury (critical injury) and lastly grade 6 is a possibly fatal injury. Sum the squares of the three highest values of the three most severely injured body parts. The problem with the ISS is that injuries within the same anatomical area are only counted once. A fractures femur will receive an ISS of 9, regardless if the femur fracture is bilateral or not. Bilateral fractured femur has a high mortality rate (about 6%), mostly due to Acute Respiratory Distress Syndrome (ARDS).
The New Injury Severity Score (NISS) will have the three highest values regardless of the anatomical region and this will give credit for the bilateral femur fractures and it is more predictive of complication and mortality than the ISS.
The mangled extremity severity score (MESS) is used to decide whether to amputate or not. The ISS does not have any impact on the Mangled Extremity Severity Score. Soft tissue injury (most important), bony injury, limb ischemia, shock, age of the patient, and plantar sensation are indications for amputation. Plantar Sensation is controversial and no longer an absolute indication for amputation. The outcome, especially return to work, is not realty different between amputation and reconstruction of the extremity at 2 years follow up.
If you have multiple fractures of the foot and no pulse, you have an open would with a lot of soft tissue damage, then you will perform an amputation especially if the patient is older. Remember, early wound coverage helps to prevent the complication of infection.
The systemic inflammatory response syndrome (SIRS) is usually a response to trauma. There will be elevated cytokines, complement proteins and hormones. The response can be very intense and it is usually associated with condition such as the disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), acute renal failure, shock and multisystem organ failure. How do you diagnose SIRS? The patient will have a heart rate more than 90, a white blood cell count less than 4 or more than 12, respiratory rate of more than 20 and a temperature that is less than 36 or more than 38. Each one of these will get one point if they meet the outlined criteria. You have SIRS when there is a score of 2 or more.
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[@co4421]

Brilliant summary. Thank you Dr Ebraheim!

[@TheVishu27]

awesome video as usual... continue such surgical uploads sir...

[@apexxxx10]

*Greetings from Lerdsin Hospital, Orthopedic Ward 17. Again, thank for your excellent contribution. Johnnie de Bangkok*

[@homologouschromosomes5272]

🎉thank you

[@gospodjicaDV]

Great!

[@sundarkarki3991]

Sir can you make detail video on MESS Score? Thank you

[@drabduabd]

شكرا د نبيل فيديوهات حضرتك بتساعدني جدا جدا في العظام

[@dearson299]

فعلا

[@Gnokhi]

Nice... But from 2016 (SEPSIS-3), SIRS, Severe SIRS, Severe Sepsis are all abandoned...