Polytrauma: The Nervous System & Physiological Systems
With ongoing wars in Iraq and Afghanistan, increasing numbers of civilians and military personnel are being exposed to explosive blasts. The injuries caused by these blasts are devastating, wreaking havoc on many parts of the body at once. The physicians and healthcare specialists treating the victims of these blasts must be aware of the complexity of injuries involved.
In past wars, soldiers with multiple blast wounds were likely to die on the battlefield, but now the chances of being rescued are much higher. Medic teams can safely extract soldiers from battle zones using air transport and deliver immediate medical care. With increasingly sophisticated rescue efforts, more soldiers are surviving massive injuries. And when they return home, they need intensive long term rehabilitation.
Blasts cause polytrauma—multiple complex injuries usually involving both brain and body. Polytrauma manifests itself in unpredictable patterns that are not easily traceable to particular locations or systems in the body. Doctors mistakenly attribute many post-war symptoms—cold intolerance, reduced aerobic capacity, sexual dysfunction—to brain damage alone when in fact the pathology is widespread, involving multiple hormonal pathways. Conversely, symptoms of brain damage are often misdiagnosed as various types of body injury. For instance, a person with a concussion may have seemingly unrelated symptoms such as nausea and vomiting.
The problem is that the brain and body are intimately entangled systems. The brain secretes chemicals that control activity in the tissues, and the tissues secrete chemicals that influence the brain. Regulation is bidirectional, and cause-effect relationships are difficult to decipher.
When a blast-survivor patient visits a doctor for a particular problem, the doctor should look at the brain-body system. If the patient presents a head injury, the doctor should examine the body, and if the patient presents a body injury, the doctor should examine the head. Blast injuries are complex and require a multidisciplinary treatment approach. Neurologists, endocrinologists and other specialists need to work together in treating these patients with polytrauma.
Recently, a group of experts convened to address these issues. Rolland Parker, president and founder of the New York Academy of Traumatic Brain Injury, spoke before the New York Academy of Traumatic Brain Injury Annual Conference.
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