Trauma

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Trauma

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(Resuscitation in Trauma)

(golden period) 60






(preventable death)


10-15

( 85-90)
(stable)

- Primary survey

- Resuscitation

- Secondary survey

- Definitive care
Primary survey

(resuscitation)



(airway with cervical spine control), (breathing), (circulation) "ABCs"
Resuscitation

, , fluid resuscitation,
Secondary survey

, ,

,

, CT scan, diagnostic peritoneal lavage

exploratory

laparotomy

secondary survey
Definitive care


, craniotomy

exploratory laparotomy

, (Intensive Care Unit, ICU)

- Airway with cervical spine control

posterior pharynx, soft tissue ,
, (foreign bodies), ,



(
, ), (severe maxillofacial trauma)



hypoxia, , , accessory muscles of respiration
,






(cervical spine)


, (maxillofacial injury),

,
,

support cervical spine cervical collar

(endotracheal intubation)

1. (acute airway obstruction)

2. (apnea)

3. hypoxia

4.
hematoma

5.

Glasgow Coma Scale 8

6.

(nasotracheal intubation), (orotracheal intubation), surgical airway

cricothyroidotomy tracheostomy

1. cervical spine injury

2.

3. (spontaneous breathing)

4.

http://www.rcst.or.th/view.php?group=8&id=205[8/4/2016 05:04:49]

Trauma

(orotracheal intubation)

cervical spine injury




absolute
contraindication

cervical spine injury


(in-line stabilization)

(blind nasotracheal intubation)

( spontaneous breathing)

(maxillofacial injury)


cervical spine injury


(orotracheal intubation)

surgical airway

surgical airway




(severe maxillofacial injury) surgical airway



cricothyroidotomy tracheostomy

- Breathing and ventilation

primary survey tension pneumothorax, flail chest with pulmonary contusion, open pneumothorax,
massive hemothorax
massive hemothorax

hypovolemic shock (circulation)
Tension pneumothorax

blunt penetrating trauma

, bronchi, trachea

hypoxia
trachea shift , distended neck vein,

, cyanosis,

(air hunger)
tension pneumothorax

tension pneumothorax ( 14 16) syringe intercostal space 2 midclavicular line
chest tube (tube thoracostomy) intercostal space 4 5 mid axillary line chest tube ( 36)

Flail chest

separation costochondral junction

2 1 3
1
sternum
lung contusion, pneumo hemothorax flail chest
paradoxical respiration
hypoxia

hypoxia lung contusion

, intercostal nerve block epidural analgesia
pneumo hemothorax chest
monitor oxygenation endotracheal tube
tube fluid resuscitation
fluid
pulmonary capillary
Open pneumothorax

2/3 trachea "sucking chest wound"


respiratory distress


sterile occlusive dressing chest tube

endotracheal tube

Massive hemothorax

1500 ml tension pneumothorax

engorged neck vein
chest tube fluid resuscitation chest tube 1,200 - 1,500 ml
thoracotomy chest tube 100-200 ml. (4-6
) thoracotomy

- Circulation and hemorrhage control

cardiac tamponade penetrating injury neurogenic shock
( mid thoracic level
)

(systolic blood pressure < 90 mmHg.) 30 total blood volume
pulse pressure ( systolic diastolic)

pulse pressure
(tachycardia) hypovolemia

15 total blood volume

hemorrhagic shock intravenous fluid 2
2 ( 16)
matching grouping resuscitate balanced saltsolution Ringers lactate solution Ringers acetate solution

resuscitate colloid hydroxyethyl starch, gelatin, albumin

intravascular volume


venous access

route of fluid resuscitation
hemorrhagic shock saphenous vein cutdown
, saphenous vein cutdown
, basilic vein cutdown
, femoral vein catheterization
subclavian vein (subclavian vein catheterization) fluid resuscitation ( pneumothorax)

fluid resuscitation hemorrhagic shock



pressure ( ), ,
active bleeding elastic bandage


severe maxillofacial injury Foley catheter
balloon balloon posterior nasal packing (
running suture
),



hemorrhagic shock

1.

2. retroperitoneal area

3. (

)

4.
(thigh)

femur

http://www.rcst.or.th/view.php?group=8&id=205[8/4/2016 05:04:49]

Trauma

- , chest tube

thoracotomy

- diagnostic peritoneal lavage

exploratory

laparotomy

-

femur

2008-02-12 62968

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http://www.rcst.or.th/view.php?group=8&id=205[8/4/2016 05:04:49]