DR. MUDDATHER ABDUL-AZIZ MOHAMMED
Trauma Injury Multiple injured patient pathological vs clinical overt and covert injuriesPRIMARY SERVEY AMPLE HISTORY SECONDARY SERVEY DEFINITIVE MANAGEMENT CONT. RE-EVALUATION PATIENT REFFERAL & DISPOSITION
ABC’s - Identified and simultaneous management of the life-threatening conditionsA – Airway management with C-spine controlB – BreathingC – Circulation & hemorrhage controlD – Disability: neurologic statusE – Exposure & environmental control
A -Airway way (with cervical spine protection) Stabilization of cervical spine- neck collar +head blocksInspection for foreign bodies – remove ---BUT NO BLIND FINGER SWEEP IN CHILDREN Suction – remove blood & secretionsJaw-thrust maneuver; +Oropharangeal airway, LMA etc –KEEP UPPER AIRWAY PATENT.
Rapid sequence intubation (RSI) DIFINITIVE AIRWAY Head trauma GCS < 8 Facial trauma Laryngeal trauma Neck trauma Burn or inhalational injury Patient in extremis Cricothyroidostomy --- NEEDLE OR SURGICAL Alternative Airway
Suspicion of C-spine injury Multiple trauma history?Severe face & head traumaInjuries above the clavicle➣ Neurologic examination does not exclude C-spine injuryNECK COLLAR- HEAD BLOCKS---- Initial trauma management
B- Breathing * Listen for breath sounds and palpate the chest No breathing ------- start ventilation (BVM OR Pocket mask) *Breathing with equal breath sounds bilaterally STAT Chest x-ray & continue with primary survey *Breathing with unequal breath sounds------- pneumothorax Unstable patient----- needle decompression------chest tube Stable patient-----------wait chest x-ray if immediately available Flail chest ------ immobilization + PPV.
Open pneumothorax THREE SIDED AIR TIGHT dressing
Is the patient breathing? Look, listen, & feel for 10 seconds
Blood volume & Cardiac output Pulse Capillary refill > 2 sec Skin color Level of consciousness BLOOD PRESSUREInitial trauma management
TO STOP OR MINIMIZE FURTHER BLOOD LOSS
VOLUME REPLACEMENTBalanced salt solution: Ringer’s Lactate or normal salineIn hypovolemic patient - 2 L rapidlyRapid responseTransient response UnresponsiveBloodType specific cross-matchedType specific unmatchedO – negativeO - positive Initial trauma management
Hemorrhage should be identified & controlled in the primary survey Direct pressure Pneumatic splints Tourniquets ????? Operative repair of the major intra-thoracic or intra-abdominal bleeding (DAMAGE CONTROL SURGERY) ASSESS FOR CARDIAC TEMPONADE ---- Drain CARDIAC ARREST START---- CPR
Initial trauma management
IN HOSPITAL GCS. PUPILE SIZE
Undressing Protection from hypothermia
Initial trauma management
Indicator of volume status Urethral injury suspected blood at the meatus perineal hematoma high-riding prostate by rectal examination cystogram
Initial trauma management
Remove gastric contentDecompression Help to prevent aspirationHelp to rule out upper GI bleeding➣Precautions: Suspected # of cribriform palateMaxillo-fascial trauma Initial trauma management
Should not delay resuscitation Chest AP Pelvis AP Lateral C-spine ???
Initial trauma managementA Allergies M Medications P Past illness L Last meal E Events/ environment related to the injury
Initial trauma management
AMPLE
Vital signs assessment Head to toe examination (DCABTS) Role of FAST in abdominal trauma Rectal exam . Complete neurologic examination Log roll for back exam X-rays and imaging as needed Laboratory tests
Initial trauma management
blood analyses: Type & Crossmatch CBC Chemistry PT/ PTT Alcohol/ toxicology/Pharmacology Pregnancy test for childbearing women
New findings Discover deterioration of previous signs
Initial trauma managementPRINCIPLE OF DAMAGE CONTROL DIFINITVE TRAETMENT AND CARE PROPER PATIENT DISPOSITION REHABILITATION AND RETURN TO UASUAL LIVE