principles of trauma management
TRANSCRIPT
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PRINCIPLES OF TRAUMA MANAGEMENT
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TRAUMA: TRAUMA IS THE STUDY OF MEDICAL PROBLEMS ASSOCIATED WITH PHYSICAL INJURY
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ATLSADVANCED TRAUMA LIFE SUPPORT
TRAUMA MANAGEMENT TRAINING PROGRAM ……..1970’s IN USA.
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BASIS IN ATLS:TREAT LETHAL INJURY FIRST, THEN REASSESS AND TREAT AGAIN
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ATLS COMPONENET STEPS: PRIMARY SURVEY: (Identify what is killing the patient) RE SUSCITATION: (Treat what is killing the patient)
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SECONDARY SURVEY: (Proceed to identify all
other injuries) DEFINITIVE CARE: (Develop a definitive management plan)
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PRE HOSPITAL RETRIVAL AND MANAGEMENT: “Golden hour”
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POLICIES: Scoop and run Stay and play
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Gloves Two finger sweep Suction Chin lift and jaw thurst
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Airway patency: - oropharyngeal
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Nasopharyngeal airway
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Endotracheal tube:
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Cricithyroidotomy:
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Stabilise cervical spine Oxygenation Covering and sealing of open
chest wound Control of external bleeding by
pressure Save IV access with two wide
bore cannulas
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Neurological status: “AVPU” method A – alert V -- response to Voice P-- response to Pain U-- Unresponsive Pupils , size and reaction
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Obvious long bone fracture: alignment and traction splint
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MANAGEMENT IN HOSPITAL
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PLANNING AND PREPARATION: Hospital should be informed
early Preparation of resuscitation
area
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THE TRAUMA TEAM: Multidisciplinary team approach Trauma team leader Additional physicians…. Airway
management, primary and secondary survey
Radiographers Neurosurgeon General surgeon Orthopedic surgeon Spokes person
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Handing over the patient: “MIST” M.. Mechanism of injury I.... Injuries identified S…vital Signs at the scene T…Treatment given
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PRIMARY SURVEY AND RECUSCITATION :
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ABCDE of trauma management: A- Airway maintenance and cervical spine protection B- Breathing and ventilation C- Circulation with haemorrhage control D- Disability: neurological status E - Exposure, completely undress the patient and assess of other injuries
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AIRWAY AND CERVICAL SPINE PROTECTION: Check verbal response Inspection :foreign bodies fractures :maxilla, mandible injury: trachea, larynx edema
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GCS: < 8 …..definitive airway Oxygen supplementation Injury to cervical spine: - injury above clavicle - loss or alteration of
consiousness -history of neck pain
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AIRWAY AND BREATHING: Exposure Examination -inspection -palpation - percussion -auscultation
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Immediately life threatening thoracic conditions: 1: Aairway obstruction
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2: Tension pneumothorax T/M: ( needle
thoracocentesis , tube thoracostomy)
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3: Open pneumothorax: (sucking wound) T/m: 3 sided dressing, tube thoracostomy
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Massive hemothorax ( >1500 cc blood) T/m : active resuscitation
followed by tube thoracostomy)
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Flail segment with pulmonary contusion
T/m: endotracheal tube with mechanical ventilation
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Cardiac temponade T/m: needle
percardioncentesis followed by thoracotomy and repair
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CIRCULATION AND CONTROL OF BLEEDING: CONSIOUS LEVEL SKIN COLOUR PULSE
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IV assess: 2 wide bore cannulas Venous cut down Blood grouping and cross
matching Fluids given 20 ml/kg body weight
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Responces : 1: immediate and sustained
return 2: transient response with later deterioration 3: no improvement
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DISABILITY: Glascow coma scale Hypoglycemia, alcohol and
drug abuse
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EXPOSURE:Log roll:
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Spinal allinment
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Hypothermia -> warming air blankets
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ADJUNCTS TO PRIMARY SURVEY: ECG Urinary catheter Gastric catheter Radiograph of cervical spine
and chest and pelvis Specialised imaging: ultrasound,
CT scan, angiography, diagnostic peritoneal lavage
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SECONDARY SURVEY:
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Patient’s history: “AMPLE” A: allergy M: medication including
tetanus P : past medical history L: last meal E: events of the incident
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HEAD TO TOE EXAMINATION:
Head and face: Open head fracture Ocular injury Facial fracture Bleeding or discharge from ear
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NECK: Inspect and palpate Cervical spine stabilisation Wound exploration if platysma
deep
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CHEST:
Inspection (log roll) Palpation percussion auscultation
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NEUROLOGICAL:
GCS re- evaluation after every 15 min
Full neurological examination
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ABDOMEN AND PELVIS:
Inspection: abdomen, prenium Palpation Rectal examination
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EXTREMITIES:
Obviously deformed limbs Document neurovascular
status Movements of joints
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RE- EVALUATION:
Vital signs Urinary out put (0.5 ml/kg) Pulse oximetery Details examination of hands,
feet and ankels
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ANALGESIA: Pain and anxiety can change
vitals Titrated intravenous dose of
opiate
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DOCUMENTATION AND LEGAL CONSIDERATION: Time documentation Consent Forensic evidence
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DEFINITIVE CARE AND TRANSFER: Transfer of the patient to
respective department for further management
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TAKE HOME MESSEGE: “EARLY TRANSFER OF INJURED
PATIENT AFTER EFFECTIVE AND AGGRESSIVE INITIAL RECUSITATION IS THE MOST IMPORTANT CONTRIBUTOR OF SUCCESSFUL OUTCOME”
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