Assesment of

Multiple Trauma Patient

Mirna Phandu

Lecturer :
 Initial Assesment of
Multiple Trauma Patient
Preparation ( prehospital phase, hospital phase )

Triage

Primary Survey + resuscitation

• Adjuncts to primary survey and resuscitation : ECG, gastric catheter
• Consider need for patient transfer

Secondary survey
• Adjuncts to secondary survey

Continued postresuscitation monitoring and reevaluation

Definitive care
 Preparation : Prehospital Phase
Every effort should be made to minimize scene
time!

Emphasis should be placed on : airway maintenance, control

of external bleeding and shock, immobilization of the
patient, immediate transport to the closest appropriate
facility/trauma center

Also important : obtaining and reporting

information needed for triage at the hospital
 Preparation : hospital phase
Triage area

Resuscitation area

Ready to use equipments

Ready healthcare personnels

( doctors,nurses)

Ready to call additional medical assistance

 Triage

Sorting of patients based on their need for

treatment, and the decision regarding to which
medical facility they should be transported

Useful in multiple casualties and

mass casualties
 Primary Survey+Resuscitation
Airway maintenance with
cervical spine protection
Quick, simple way to asses
Breathing and ventilation the patient in 10 seconds!

Circulation with Life threatening conditions

hemorrhage control are identified, and
management is instituted
Disability : neurologic simultaneously!!
status
Prioritized assessment and
Exposure management are in sequential
steps in order of importance!!
 Airway + • Recognition of patient with
potency of airway
C-Spine Control compromise airway control
• C-spine control

We do :
•Cleansing the
airwaysuction
•Jaw thrust, chin-lift
•Oropharyngeal airway
•Definitive airway (
endotracheal intubation,
tracheostomy
•C-spine control should
be indicated in every
multiple trauma patient
 Breathing and ventilation
• Quick assesment !! :
– Inspection : •Rib fractures
• Freq of the resp rate •Pneumothorax
• Chest shape and •Hematothorax
movement •Hematopneumothorax
– Percussion : •Flail chest
sonor/hipersonor/dull
•Lung contusion
– Palpation: crepitation,
tenderness •Tension pneumothorax
– Auscultation: •Cardiac tamponade
normal/decreased VBS

We do :
Oxygenation, portable chest x-ray, chest tube insertion
Monitoring the oxygen saturation,ventilatory support
 Circulation and Hemorrhage control
• Quick assesment !! : •Hypovolemic shock
– HR •Cardiac shock
– Blood pressure •Distributive shock
– Skin perfusion
•Spinal shock
– Urine output
•Septic shock

We do :
put 2 large bores IV needles,2000cc warmed crystalloid
infusion,blood crossmatch,urine catheter insertion,
hemorrhage control
 Disability : neurological examination
• Quick assesment !!
– GCS No head injury
– Pupils Mild head injury
– Neurological exam : Moderate head injury
motoric and sensoric
function Severe head injury

We do :
oxygenation, consider intubation in severe head injury,
head up, immobilization of the spine
 Sothe
At when
samewe dowhen
time the the
history taking?what
patient is on primaryis
important
survey in history taking of multiple
and resuscitation
trauma patient?
should be quick, practical and organized

• Chief complain
• Onset of trauma!
• Mechanism of trauma!
• Injury sustained
 Secondary Survey
It is the time for Head-to-toe examination of the trauma
patient, combined with complete history and physicial
examination.
It is the time for recognizing the less
dangerous injury,

It is the time to do more sophisticated

investigation

It is the time to give further treatment for

the injury

Shouldn’t start if the primary survey is not

finished or clear!!!
Continued Postresuscitation Monitoring
and Reevaluation
• Depends on the trauma type
• Depends on the facility and equipments provided by
the hospital
• Depends on the ability of the healthcare personnel
 Definitive Care
Which patients do i transfer to a higher level of
care?when should the transfer occur?
 Take Home Message
• Multiple trauma  should be managed by trauma
team
• Priority of the trauma patient is different than non-
trauma patient : all should be quick and organized
– History taking, physical examination and immediate
treatment come into one package : primary survey!!!
– Head to toe exam, complete history taking, other
sophisticated investigations, further treatments come in
secondary survey
• Equipped yourself!