Dr.

Mohamed El-Gindy
Professor of Surgery

Mansoura
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‫الحوادث المروريه فى مصر )‪(2009‬‬
‫‪ 85%‬على الطرق المحليه‬
‫‪ 15%‬على الطرق السريعه‬
‫‪ 5‬مليار جنيه خسائر ماديه‬ ‫‪ 26‬ألف حادث‬
‫‪ 25‬مليون مخالفه مرورية‬ ‫‪ 6‬ألف قتيل‬
‫‪ 23‬ألف مصاب‬
‫أخطاء بشريه‬ ‫‪% 85‬‬
‫أخطاء فنيه‬ ‫‪% 10‬‬
‫أحوال جويه‬ ‫‪% 5‬‬
Significance of trauma

Trauma is the (neglected disease) of

modern society.

It is the number one killer under the

age of 40 years and the 4th cause of

death in all ages.

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Economic cost of trauma
 The economic cost of trauma to the

nation is more than $

41 bilion annually.

 It causes permanent loss of millions of

productive work years.

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 Trauma care
" 3 Rs"
The intent of any system of trauma care
must be to fulfil the " 3 Rs"

•To get the Right patient

•To the Right hospital
•At the Right time.
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 The Right Hospital should fulfil
also

" 3 Rs"
* It can Resuscitate the victim
* It can Review (assessment, monitoring
and diagnosis)
* It can Repair (definitive treatment)

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 Level (I) Trauma
Hospital
It provides specialised trauma care " 3 Rs"

(Resuscitate, Review & Repair) .

Educate physicians and paraprofessionals in

trauma care.

Undertake trauma research.

Treat a certain number of severly injured

patient every year.

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 Trauma Categories
l) Those with injuries that are rapidly fatal (5%)

Death is inevitable
2) Stable patients (80%)

They need little expertise

3)Those with life threatining injuries and required
urgent medical attention (15%).

They need more expertise

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Mechanisms of Injury
Blunt mechanisms
Forces
Compression forces
Shearing forces
Deceleration forces
Sources
MVCs
Seat belt injury
Steering wheel
injury
Falls
Assaults
Blast
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 Mechanisms of Injury

Penetrating mechanisms
Low velocity
Knife
ice pick
Medium velocity
gunshot/handgun
shotgun
High velocity
high power hunting rifle
military weapon

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The 3 lines of management
of the injured patient are

 Immediate measures at the

scene of accident.
 Transportation
 Emergency room care

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the victim should be

* Handled as if severe injury has occurred.

* Protected from further trauma

* Treated by trained personnel.

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 5
Q ?
1) Is the victim breathing ?

2) Is there a pulse or heart beats ?

3) Is there gross external bleeding ?

?
4) Is there any question of spine injury ?

5) Is there any obvious fractures ?

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1- Asphyxia

It may be due to

a. Airway obstruction.

b. Acute-thoracic injury.

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a. Airway obstruction

Causes:

* Blood, mucus, vomitus.

* Foreign body (e.g. broken teeth)
* Fallen tongue in comatosed
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 Management of Airway
obstruction

1. Simple manipulation of the

mandible

2. Immediate endotracheal intubation

3. Try to remove any foreign body.

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 A

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 Management of Airway
obstruction
(CONT.)
4. One or two large-bore needles through

the cricothyroid membrane.

5. A lateral and slightly head down position

6. In respiratory arrest, mouth to mouth breathing

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b. Acute Thoracic Injury

Flail Chest
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b. Acute Thoracic Injury

Open pneumothorax
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b. Acute Thoracic Injury
Tension Pneumothorax
 2. Cardiac Arrest:
*Absence of heart sounds and pulse
*immediate action within 4 minutes.

Mouth to mouth breathing/5 cardiac

compressions.

* Place the victim on a hard surface.

*Sharp blow with the Fist to the lower
end of the sternum
*4-5 cm toward the spine once/second.
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3- HEMORRHAGE

*local pressure and elevation of the limb

*Tourniquet
*kept exposed
*loosened / 20 m. for 2 m.
*write ( TK ) on forehead
*on uper arm or thigh
*It may cause vasc. & nerve damage
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Shock
*1 ry Shock ( pain and fright)
*Hypovolemic shock ( loss of blood or plasma)
*patient must be recumbent

* Analgesics should be (I V(

*fluids until blood trans.

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The lethal triad

Bleeding coagulopathy

Acidosis hypothermia
4- Fracture Spine
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Pelvic Fractures
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 5-Fractures
•Splinting using boards, pillows, blankets
or any
other materials.
•Improper handling of Fractures may cause:

a. Damage of nerves, blood vessels.

b. Puncture of the skin overlying it (compound).
c. Severe pain which increase the shock state.

Exceptions of splinting fractures at the scene of

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II.Transportation

•Patients should be transported in the supine

position.

•Station wagon or truck is preferable

• Resuscitation of injured patient should be

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Is Pre hospital care

significantly improve the
outcome

* The answer is equivocal because of :

1) Delay from receiving definitive

treatment in the hospital
(2) It may have adverse effects and
compromise the patient further .
is a new Aproach

Except for

* Unavoidable delay due to entrapment.

* Inaccessible sites.
.* In rural locations
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The prehospital care directly
affected by:

Size & demography of the population 2)( 1

Local geographical constraints

3) Rural or highly urbanized area

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Fire and police services do the BASIC support .*

* Emergency paramedics do the advanced skills and

communication links with the receiving hospital .

* Severely injured patient may bypass the

nearest facility to the proper trauma centre

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Greater dependence on ambulance services*

augmented by paramedics and physician led teams

*Transport rapidly to the nearest hospital

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Hopping for
1-The Basic Care by the

police man

2- Augment the ambulance service

3- Paramedic & physician in each

4- Advanced skills by the team inside

 Hopping for

Transportation to the nearest hospital ??

Augment the communication links

7- Accident flying squads using Helicopters

in inaccessible sites

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 III Emergency Room Care
1- General Principles :

1) Patient clothing (cut off).

3) History of :

a. medical diseases.

b. circumstances of the injury .

4) Findings should be "written records“

(for medicolegal and follow up

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Do not remove the stab
.except in OR
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Impalement Injury
Small Intestine Injury

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III Emergency Room Care

2. Resuscitation

a. I.V catheters b. I.V Fluids

c. (C. V. P.) d. Foley’s

catheter

e. Antitetanic, antigasgangrene serum if

 III Emergency Room Care
3 Laboratory Studies
* Hematocrit.

* Blood count, blood sugar level.

* Serum creatinine, blood urea nitrogen.

* Blood grouping and proper cross matching of

blood.

* Serum electrolytes.

* Urine analysis for sugar and hematuria if

 III Emergency Room Care
4. Radiological Study

* X-ray chest and abdomen in all cases of major injury.

* I.V.P. in abdominal and pelvic injuries with evidence of

urinary

tract injury

* X-ray skull, C.T. scanning of the head in most of head

injuries.
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Thermal Trauma
Extensive Thermal Trauma
 Special Bed for Extensive Thermal Trauma

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Bullet Injury of the
heart and abdomen

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Extensive Fissure Fracture of the Skull
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 Blunt Abdominal Trauma

Flank ecchymosis from internal bleeding

 Blunt Closed Abdominal Trauma

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•Certain injuries are so critical that

operative treatment must be undertaken as
soon as the diagnosis is made ( penetrating
wound of the heart , abdominal wounds
involving the aorta and vena cava )
•Cerebral injuries take priority in care
only when there is rapidly deepening coma and
evidence of extra dural bleeding .
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Laparotomy for abdominal injury and

craniotomy for cerebral injury can be
carried out simultaneously .

Fractures of long bones can be treated on

a semiemergency bases unless

there is associated vascular
injury or open fractures
Hand injury should be treatment as early
If the patient is comatosed :
The cause may be :

• Alcoholic intoxication .
• Cerebro vascular accident .
• Diabetic coma .
• Barbiturate Poisoning
• Hypovolemic shook .
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