Assesment of Multiple Trauma Patient

Plenary LectureBy

Freda S.Halim, SpBPelita Harapan University

2012

Initial Assesment of Multiple Trauma Patient

Preparation ( prehospital phase, hospital phase )

Triage

Primary Survey + resuscitation• Adjuncts to primary survey and resuscitation : ECG, gastric catheter• Consider need for patient transfer

Secondary survey• Adjuncts to secondary survey

Continued postresuscitation monitoring and reevaluation

Definitive care

Preparation : Prehospital PhaseEvery effort should be made to minimize scene time!

Emphasis should be placed on : airway maintenance, control of external bleeding and shock, immobilization of the patient, immediate transport to the closest appropriate facility/trauma center

Also important : obtaining and reporting information needed for triage at the hospital

Preparation : hospital phase

Triage area

Resuscitation area

Ready to use equipments

Ready healthcare personnels ( doctors,nurses)

Ready to call additional medical assistance

TriageSorting of patients based on their need for treatment, and the decision regarding to which medical facility they should be transported

Useful in multiple casualties and mass casualties

Primary Survey+ResuscitationAirway maintenance with cervical spine protection

Breathing and ventilation

Circulation with hemorrhage control

Disability : neurologic status

Exposure

Quick, simple way to asses the patient in 10

seconds!

Life threatening conditions

are identified,

and management is instituted simultaneou

sly!!

Prioritized assessment

and management

are in sequential steps in order of

importance!!

Purpose :

Airway +C-Spine ontrol

• Recognition of patient with potency of airway compromiseairway control

• C-spine control

We do :• Cleansing the airwaysuction• Jaw thrust, chin-lift• Oropharyngeal airway• Definitive airway ( endotracheal intubation,

tracheostomy• C-spine control should be indicated in every

multiple trauma patient

Breathing and ventilation

• Quick assesment !! :– Inspection :

• Freq of the resp rate• Chest shape and movement

– Percussion : sonor/hipersonor/dull

– Palpation: crepitation, tenderness

– Auscultation: normal/decreased VBS

We do :Oxygenation, portable chest x-ray, chest tube insertionMonitoring the oxygen saturation,ventilatory support

• Rib fractures• Pneumothorax•Hematothorax

•Hematopneumothorax• Flail chest

• Lung contusion• Tension pneumothorax• Cardiac tamponade

Tension pneumothorax!

Circulation and Hemorrhage control

• Quick assesment !! :– HR– Blood pressure– Skin perfusion– Urine output

We do : put 2 large bores IV needles,2000cc warmed crystalloid infusion,blood crossmatch,urine catheter insertion, hemorrhage control

•Hypovolemic shock• Cardiac shock

•Distributive shock• Spinal shock• Septic shock

Hypovolemic shock : grade 1,2,3,4

Disability : neurological examination

• Quick assesment !! – GCS– Pupils– Neurological exam :

motoric and sensoric function

We do : oxygenation, consider intubation in severe head injury, head up, immobilization of the spine

No head injuryMild head injury

Moderate head injurySevere head injury

So when we do the history taking?what is important in history taking of multiple trauma

patient?

At the same time when the patient is on primary survey and resuscitation

• Chief complain• Onset of trauma!• Mechanism of trauma!• Injury sustained

should be quick, practical and organized

Secondary SurveyIt is the time for Head-to-toe examination of the trauma patient, combined with complete history and physicial examination.It is the time for recognizing the less dangerous injury,

It is the time to do more sophisticated investigation

It is the time to give further treatment for the injury

Shouldn’t start if the primary survey is not finished or clear!!!

Primary survey

Secondary survey

Continued Postresuscitation Monitoring and Reevaluation

• Depends on the trauma type• Depends on the facility and equipments

provided by the hospital• Depends on the ability of the healthcare

personnel

Definitive Care

• Which patients do i transfer to a higher level of care?when should the transfer occur?

Take Home Message• Multiple traumashould be managed by trauma team• Priority of the trauma patient is different than non-

trauma patient : all should be quick and organized– History taking, physical examination and immediate

treatment come into one package : primary survey!!!– Head to toe exam, complete history taking, other

sophisticated investigations, further treatments come in secondary survey

• Equipped yourself!

Source

• Advanced Trauma Life Support, 2008• Feliciano and Moore, Trauma, 2006,6th ed

THANK YOU