[Diagnosis and tactics in multiple trauma]

It is difficult to establish the diagnosis in combined injuries because of the peculiar pathogenesis leading to unusual symptomatology and diagnostic errors. This is associated with some peculiarities of a combined injury: it is marked by the syndrome of mutual aggravation; signs of less severe injuries often come to the forefront; the usual complex of symptoms may be indistinct or even absent. For instance, in internal hemorrhage combined with contusion of the brain arterial pressure may be normal or even increased, while the signs of "acute abdomen" may not be manifested as the result of diminished abdominal reflexes. At the same time pain in the region of the anterior abdominal wall simulating the picture of generalized peritonitis may be caused by traumatic compression of the thoracolumbar nerve roots. Under such conditions, the standard scheme of examination of the patients makes it possible to answer two main questions in the shortest time: whether the patient needs an emergency operative intervention, and if he does, on which organ or system should the operation be performed first. With this scheme, instrumental methods of examination acquire primary significance and special diagnostic value because physical examination and the medical history often lose their importance. Such methods are thoraco- and laparocentesis, contrast roentgenography, determination of C.V.P. etc. Moreover, such tactics facilitates recovery of the patients from shock because these methods are diagnostic and, at the same time, therapeutic.