. Why is Trauma Care Important? Leading cause of death in those <40 y 3rd leading cause of death in all ages Significant loss of work force productivity Background Trimodal distribution of death
50% die at scene What do they die of? 50% survive to hospital but then die 30% die during golden hour 20% die after prolonged hospital course In ER Patients in their Golden Hour must: Be recognized quickly Have only immediate life threats
managed Be transported to an APPROPRIATE facility In ER Survival depends on assessment skills Good assessment results from An organized approach Clearly defined priorities Understanding available resources Preparation yourself
Primary survey Airway Maintenance with Cervical Spine Protection Signs of airway obstruction Inspection for foreign bodies Chin lift or jaw thrust
GCS of 8 or less definitive airway management Prevent excessive movement of the cervical spine Inline immobilization techniques Breathing and Ventilation Assess chest wall excursion Auscultation Visual inspection and palpitation B : Breathing and Ventilation
Objective sign Look : Symmetrical expansion Paradoxical movement Location and depth of the wound Listen : Breath sound Pulse oximeter :
Measure oxygen saturation. B : Breathing and Ventilation Objective sign Pulse oximetry Pa O22 level O22 Hbg Saturation levels 90 90 mm
mm Hg Hg 100 100 % % 60 60 mm mm Hg Hg
90 90 % % 30 30 mm mm Hg Hg 60 60 % %
27 27 mm mm Hg Hg 50 50 % % Circulation with Hemorrhage Control 1. blood volume and cardiac output
Level of consciousness : impaired cerebral perfusion Skin color : gray skin of face, white skin of extremities Accessible central pulse (Primary Radial = 80 mmHg., femoral=70 mmHg., carotid=60 mmHg) Absent central pulses : immediate resuscitation Circulation with Hemorrhage Control 2. bleeding External hemorrhage is identified
and controlled in the primary survey Direct manual pressure Pneumatic splinting devices Tourniquets hemostat Disability (Primary Neurologic Evaluation ) Alert Verbal Pain Unresponse Pupillary size and reaction Lateralizing signs
Spinal cord injury level GCS Exposure/Environment Control Completely undressed Prevent hypothermia Warm blanket Warmed IV Warmed environment (Primary room temperature) What should you do
ET tube or not C spine protection
ICD or ET-tube ICD single or both Oxygen saturation 3 sides coverage NG tube or OG tube foley catheter Hemorrhage control FAST DPL Unseen wonud What should you do
Secondary survey A allergy M Medication P past illness / pregnancy L last meal E event / environment
Physical examination (trauma system) 1. Head 2. Maxillofacial 3. Neck 4. Chest 5. Abdomen 6. Perineum (Primary back , axilla) 7. Extremity 8. Neuro - exam Film x-ray
A airway trachea R L main bronchus ET tube position tube carina 2-3 cm. B breathing lung parenchyma pleural line costophrenic angle C cardiac shadow heart ratio 0.5 mediastinum 8 cm. D diaphragm , E emphysema subcutaneous emphysema
F Fracture rib Film C-spine A alignment 4 -anterior , posterior , spinolamina , spinous process B bone 2-7 C cartilage and disc prevertebral soft tissue swelling Film pelvis AP 6
Un corrected ER triage Uncontrolled Management system Medical personnels
Visitors and press Pitfall in primary survey and c-spine control Delay or inadequate airway control
Delay or undetection of c-spine injuries Delay or undetected chest injuries
Inappropiate fluid resuscitation Undetected wound of back or perineal wounds A blood pressure or an exact respiratory or pulse rate is NOT necessary to tell that your patient is critical !!!!!
If the patient looks sick, hes sick!!! primary survey c-spine chest injuries pelvis perinium rectal examination long bone
Investigation CT abdomen angiogram vascular Investigation injuries film chest, pelvis, c-spine multiple trauma investigate coma score
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