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INITIAL ASSESMENT

MANAGEMENT
SYAFRI K.ARIF
Dept.of Anesthesiology,Pain Management and Intensive Care
Faculty of Medicine Hasanuddin University
Makassar-Indonesia

INTRODUCTION
The main role of the doctor is
 SAVING LIFE
 ALLEVIATE SUFFERING
Any doctors should have these
competences.
The main tool of saving life is
“BASIC LIFE SUPPORT “

ACCIDENTS OR DISASTERS
Accidents or disasters may occur to
:
 ANY WHERE
 ANY TIME
 ANY ONE
Well preparedness is very important
( soft-ware and hard-ware )

What is “EMERGENCY” in Medicine ?
A medical condition that starts suddenly and
requires immediate care
A life or limb threatening medical
condition resulting from an injury or
sickness that requires immediate
treatment and, if left untreated, could
result in permanent harm to the person.

Some Example of Emergency Conditions Conditions such as: heart attack. including obvious fractures. or severe or multiple injuries. convulsions. loss of consciousness. . severe allergic reactions. severe shortness of breath or difficulty breathing. uncontrollable bleeding. poisoning.

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leading cause death age 1 to 40 years > 100.The Cause of Death in US      Traffic accidents are the third cause of mortality after CVS and Cancer Disease of the young.000 death /year in US Loss of productive work years Trauma management is expensive .

Epidemiology of Trauma Death  Trimodal patterns  ATLS Donald Trunkey 50% 30% Death % sec hr 20% days/week .

education & awareness .Trauma Death  First Peak  Death that occurs at impact or soon after the accident  50 % death  Not preventable  severe head laceration. heart injury etc.  Prevention of accidents  enforcement. massive bleeding.

breathing .Trauma Death  Second Peak     Death within minutes to hours after injury “ Golden Hours ” 30 % of death Life threatening injuries involving airway. circulation .

secretion & blood. vomitus  difficult airway management Breathing & Ventilation  pneumothorax. flail chest Circulation  hemorrhage.heamothorax.Trauma Death    Airway  obstruction: tongue. penetrating chest injuries. cardiac tamponade .

efficiency of EMS in prehospital resuscitation hospital emergency department resuscitation definitive therapy .Second Peak   Preventable Reflect    adequacy.

Third peak  Third Peak     Death within days or week after injury 20 % death Sepsis or multiorgan failure Reflects again efficiency at resuscitation. definitive care. aggressive ICU care. prevention of infection and rehabilitation .

Preparation 2. Triage 3. Secondary Survey ( Head to toe evaluation ) 6.INITIAL ASSESMENT Initial assessment include : 1. Resuscitation 5. Primary Survey ( ABCDE ) 4. Definitive Care .

PREPARATION Preparation of the trauma patient occurs in two different clinical settings 1. PRE-HOSPITAL PHASE 2. IN HOSPITAL PHASE .1.

PRE HOSPITAL Transportation is very important .

effective ventilation. hemorrhage control & restoration of adequate blood volume .Prehospital Trauma Resuscitation  Definitive care ? GOALS  A clear airway.

226-240 .Pre hospital Care  Ambulance Response Time: Standard  50 % of all calls are responded within 8 min. Pars.79.  95 % of calls within 14 min. BJA 1997. (rural )  Nolan JP. (urban)  95 % of calls within 19 min.

Pre hospital Communication  Communication Vital between prehospital & inhospital trauma patient resuscitation  Prepare ED personnel well ahead  Activation of TRAUMA TEAM / DISASTER PLAN into action  .

2. Triage    ‘trier’ sorting out Is the sorting of patient based on the need for treatment Triage   Resuscitation Room Activation of trauma team .

Trauma Team-work    Efficient method Trained doctors & nurses Variety of tasks taken simultaneously   horizontal organization reduced time to lifesaving procedure by 50 % .

Trauma Team at Work    “ Pit stop in a formula 1 motor race ” Managing trauma in a smooth and efficient manner Do no further harm .

3. The Primary Survey      Airway & cervical spine control Breathing & ventilation Circulation & haemorrhage control Disability Exposure/Environment .

Airway & Cervical Spine Control   Difficult Airway Goal    Keep airway patent protect compromised airway provide airway if none .

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Cervical spine Fracture  Suspect:      Unconscious patients Injury above clavicles Neck pain Weakness or neurological deficit History of fall > 6 m .

cardiac tamponade Goals: Avoid Hypoxia. Bad for the Brain . Hypercarbia. Not Recordable….. lung contusion. BLUE. BP DOWN. BLUE.. BLUE. Think :Tension Pneumothorax. haemotothorax.Breathing & Ventilation    Patient in increasing respiratory distress. Flail chest.

TENSION PNEUMOTHORAX .

Flail Chest • Segmental ribs fracture of multiple ribs • Panel moves in with inspiration and out with expiration .

Cardiac Tamponade .

Treatment of Cardiac Tamponade .

200 ml/hr CLAMPED CT Urgent thoracotomy .Hematothorax Chest tube Massive : > 1500 ml blood Drainage: .

blood products .Circulation Haemorrhage Control with Fluid therapy  First Priority : Restore volume with fluid (RL/NaCl 0.9% )  Second Priority : Restore blood with WB and PRC transfusion to restore oxygen carrying capacity   Remember : did not die of anemia but die of hypovolemic shock Third Priority : Normalize coagulation status  FFP. Platelet.

Disability ( Neurologic Evaluation )   Rapid Neurologic evaluation is perform at the end of primary survey Simple Neurologic evaluation is AVPU method  A  Alert  V  Responds to Vocal stimuli  P  Responds only to Painful stimuli  U  Unresponsive to all stimuli .

Resuscitation   Aggressive resuscitation and the management of life threatening injuries Essential to maximize patient survial  Airway should be protect and secure    Breathing/ventilation and oxygenation   Jaw thrust or Chin lift maneuver Definitive airway if needed Injured patient should received supplemental O2 Circulation  Controlled bleeding by direct pressure or operative intervention .4.

End.Points of Resuscitation  Traditional:  Achieved definitive care    Blood Pressure/ cerebral perfusion pressure/ ICP Heart rate Urine output .

5. Secondary Survey   Not begin until the Primary Survey is completed Is Head to Toe evaluation         Head Maxillofacial Cervical spine and Neck Chest Abdomen Perineum / rectum / vagina Musculoskeletal Neurologic .

6. Definitive Care   Surgical intervention Transfer to higher trauma center .

Conclusion     Trauma continues to be the most common cause of death BLS playing a big role in saving life in pre-hospital phase or in hospital “Do No Further Harm” is the basic principle of BLS ABCDE is a good guide to take action. .