TRAUMA

TRAUMA
Leading cause of death and disability
Trauma care involves multidisciplinary
team
Trauma care requires both speed and
accuracy
Identification of life threats and emergent
intervention may save life
 TRAUMA

1. Prehospital care

2. Primary survey

3. Resuscitation

4. Secondary survey
 PREHOSPITAL CARE

Prehospital providers are trained in:

– Assessment of the injury scene

– Stabilization of the injured patient

– Monitoring and transport of critically ill patient

 PREHOSPITAL CARE
Efficient method for reporting by the
prehospital providers to the trauma team:
MIVT
M= mechanism of injury
I= injury
V= vital signs
T= therapy
 MECHANISM OF INJURY
CAN PREDICT TYPES OF INJURIES
– FRONT-END COLLISION CAR: PATELLA
FRACTURE, POST.KNEE DISLOCATION,
POPLITEAL ARTERY INJURY, FR. OF THE
POST.RIM OF THE ACETABULUM
– HIGHT FALLS WITH LANDING ON FEET: CALC
FR., LOWER EXTREMITIES FR., ACETABULAT FR.,
SPINE COMPRESSION FR.
– PEDESTRIANS STRUCK BY VEHICLES: CALF FR.,
HEAD INJURY, UPPER EXTREMITY INJURIES
 INJURY INVENTORY
A trapped patient- prolonged extrication:
– Rabdomyolisis
– Traumatic asphyxia
– Hypothermia
 VITAL SIGNS
LEVEL OF CONSCIOUSNESS-
GLASGOW’S COMA SCORE
STABLE / UNSTABLE
HEMODINAMICALLY
RESPIRATION: CYANOSIS
 GCS
Less than or equal to 8 at 6 h.- 50% die
Severe head injury 3 – 8
Moderate head injury 8-13
Mild head injury 14-15
False- hypothermia, intoxication, sedation
Impossible to evaluate- dysphasic, intubated
pts. and with facial or spinal cord injury
 THERAPY
AIMED TO STABILIZING THE PATIENT
- SPINE AND EXTREMITY
STABILIZATION
- OXYGEN
- I.V. FLUIDS
- PREVENTION OF HEAT LOSS
 INITIAL EVALUATION AND
PRIMARY SURVEY

HISTORY: A M P L E

PRIMARY SURVEY: A B C D E
 AIRWAY

ASSURING THE INTEGRITY OF THE

AIRWAY IS THE HIGHEST PRIORITY IN
THE TRAUMA CARE

LOSS OF AIRWAY FUNCTION-

IRREVERSIBLE BRAIN DAMAGE
WITHIN MINUTES
 AIRWAY
SUCTION
JAW-THRUST MANOEVER
GUEDEL PIPE
TRACHEAL INTUBATION
EMERGENT TRACHEOSTOMY
 BREATHING
Once airway established- give O2
Auscultation in the axillae
– Absence of BS- SIGNALS PT or HT
Chest motions
Position of the trachea
CXR
IMMEDIATE DECOMPRESSION- CHEST
DRAINAGE TUBE
 CIRCULATION
Once airway and breathing secured- assess
circulation
BP, PR, SKIN PERFUSION- CAPILLARY
REFILL, MENTAL STATUS, URINE FLOW
The most common cause of shock in trauma is
hemorrhage:
– two venous lines
– Obtain blood for cross-matching, FBC, ABG,
basic biochemistries
 CIRCULATION
CARDIAC SHOCK- due to cardiac
tamponade or tension pneumothorax
– Prominent jugular venous distension
– Cool skin, pale, hypoperfused
NEUROGENIC SHOCK following a spinal
cord injury
– Paraplegia, quadriplegia
– Warm skin, absence of rectal tonus
 DISABILITY
Repeatedly GCS
Pts. who
– cannot follow a simple “ touch your nose”
– gross asymmetry of limb motion and pupils
Should be suspected of neurologic injury-
Emergent brain CT SCAN
 EXPOSURE
Visual inspection of the entire patient
Inspect the back- logrolling the pt.
Inspect the perineum
 RESUSCITATION
Monitoring: ECG, BP, UO, PVC, CO, PO
To assess the progress of resuscitation
 SECONDARY SURVEY
HEAD
NECK
THORAX
ABDOMEN
LIMBS
 HEAD
LACERATIONS
STEP-OFFS
GCS
PUPILS
CT
 NECK
HARD NECK COLLAR
SPINE X RAY
LOCAL TENDERNESS
HEMATOMAS
SUBCUTANEOUS EMPHYSEMA
 THORAX
LACERATIONS, WOUNDS
SUBCUT. EMPHYSEMA
CHEST MOTION
BRUISING
FLAIL CHEST
BS
 THORAX
CARDIAC TAMPONADE
NECK VEINS
HEART SOUNDS
ECHOCARDIOGRAPHY
PULMONARY CONTUSION-
VENTILATION/PERFUSION MISMATCH
Life threatening condition
 ABDOMEN
BLUNT TRAUMA:
– Hemorrhagic abdomen- internal bleeding
– Peritonitic abdomen
WOUNDS:
– Penetrating
– Perforating
Fracture of the pelvic bones
External fixation of the pelvis