Parenchymal tear as one-way Accumulation of air in pleural
valve space
Primary survey
1. Is the patient conscious or
not?
Airway 2. Head tilt & jaw thrust
3. Immobilize cervical spine
1. Look for chest movement
Motor vehicular 2. Palpate for rib fractures
3 Auscultate for breath sounds
accident, extricated 4. Check for tension
w/ minimal difficulty
pneumothorax.
Breathing
after 30 mins : 5. Supplemental O2
6. Monitored by pulse oximetry
#1: 27-year-old male
, disoriented &
drowsy
#2: 23-year old male,
unresponsive
1. Measure at least every 5
mins: peripheral pulse & BP
2. Any episode of hypotension
Circulation (SBP <90 mmHg) is assumed
to be caused by hemorrhage
1. Insert large-bore IV lines
2. Blood typing &
crossmatching
Resuscitation 3. Volume resuscitation using
isotonic solutions (NSS)
Secondary survey
1. Carried out after patient is
already stable
2. Rapid, systematic,
head-to-toe examination
3. AMPLE history
- Allergies
- Medications
- Past medical history
- Last meal
- Events/environment
related to the injury
4. How much blood at the place
of injury?
Compressed contralateral lung
and heart rotates about vena
cava
Decreased venous return and
cardiac output
Suspect tension 1. Needle thoracentesis
(+): Bubbling
pneumothorax 2. CXR (PA & lateral)
Pneumothorax :
PE Findings: needle decompression
#1:
- BP 100/60 mmHg HR 115/min RR and Left tube
29 cpm GCS 12 thoracostomy
- Diagonal contusion over his chest Source of hemodynamic
and across the waist instability
- C/L: Decreased breath sounds w/
hyperresonance and decreased
fremitus over the L hemithorax
Labs ordered:
- Abdomen: Globular, soft w/ 1. FBC: monitor urine output
CBC,Blood typing, ABG, Clotting time, X-ray results:
hyperactive bowel sounds; direct 2. CBC - Hb/HCt for
tenderness over the RUQ monitoring hemorrhage over
Bleeding time, PT, Serum Na and K To consider Pneumothorax
Normal Cervical spine FAST : laparotomy
- Left leg: open actively bleeding a period of time
Imaging: Normal mouth xray
wound w/ significant deformity & Suspect 3. ABG: index of metabolic Patient was brought to the
X-ray: Tibial Fracture (oblique)
limitation of motion intra-abdominal acidosis in the setting of Management Operating room
- Peripheral pulses were full but injury hemorrhage
Chest AP
Leg APL FAST results:
tachycardic w/ no neurologic 4. Focused Abdominal
Neck AP (+) fluid in Hepatorenal
dysfunction distal to the involved leg Sonography for Trauma
Lateral and Open mouth space
#2: (FAST)
FAST imaging (+) fluid in LUQ
Tibial-Fibula fracture
- Unresponsive 4. Abdominal CT scan
Initial : external fixation
- Limp
- Face severely disfigured Delay
- VS: 0/0 Definitive treatment
first: intramedullary
nailing
wound debridement,
wound care, antibiotic
1. Control hemorrhage using
therapy, tetanus
direct pressure vaccination
2. Extremity x-ray (AP &
Left leg
lateral)
3. Systemic antibiotics
4. Tetanus prophylaxis