TRAUMA

TRAUMA
Leading cause of death and disability Trauma care involves multidisciplinary team Trauma care requires both speed and accuracy Identification of life threats and emergent intervention may save life

TRAUMA

1. Prehospital care 2. Primary survey 3. Resuscitation 4. Secondary survey

PREHOSPITAL CARE
Prehospital providers are trained in:
– Assessment of the injury scene – Stabilization of the injured patient – Monitoring and transport of critically ill patient

PREHOSPITAL CARE
Efficient method for reporting by the prehospital providers to the trauma team: MIVT M= mechanism of injury I= injury V= vital signs T= therapy

MECHANISM OF INJURY
CAN PREDICT TYPES OF INJURIES
– FRONT-END COLLISION CAR: PATELLA FRACTURE, POST.KNEE DISLOCATION, POPLITEAL ARTERY INJURY, FR. OF THE POST.RIM OF THE ACETABULUM – HIGHT FALLS WITH LANDING ON FEET: CALC FR., LOWER EXTREMITIES FR., ACETABULAT FR., SPINE COMPRESSION FR. – PEDESTRIANS STRUCK BY VEHICLES: CALF FR., HEAD INJURY, UPPER EXTREMITY INJURIES

INJURY INVENTORY
A trapped patient- prolonged extrication:
– Rabdomyolisis – Traumatic asphyxia – Hypothermia

VITAL SIGNS
LEVEL OF CONSCIOUSNESSGLASGOW’S COMA SCORE STABLE / UNSTABLE HEMODINAMICALLY RESPIRATION: CYANOSIS

GCS
Less than or equal to 8 at 6 h.- 50% die Severe head injury 3 – 8 Moderate head injury 8-13 Mild head injury 14-15 False- hypothermia, intoxication, sedation Impossible to evaluate- dysphasic, intubated pts. and with facial or spinal cord injury

THERAPY
AIMED TO STABILIZING THE PATIENT - SPINE AND EXTREMITY STABILIZATION - OXYGEN - I.V. FLUIDS - PREVENTION OF HEAT LOSS

INITIAL EVALUATION AND PRIMARY SURVEY
HISTORY: A M P L E

PRIMARY SURVEY: A B C D E

AIRWAY
ASSURING THE INTEGRITY OF THE AIRWAY IS THE HIGHEST PRIORITY IN THE TRAUMA CARE LOSS OF AIRWAY FUNCTIONIRREVERSIBLE BRAIN DAMAGE WITHIN MINUTES

AIRWAY
SUCTION JAW-THRUST MANOEVER GUEDEL PIPE TRACHEAL INTUBATION EMERGENT TRACHEOSTOMY

BREATHING
Once airway established- give O2 Auscultation in the axillae
– Absence of BS- SIGNALS PT or HT

Chest motions Position of the trachea CXR IMMEDIATE DECOMPRESSION- CHEST DRAINAGE TUBE

CIRCULATION
Once airway and breathing secured- assess circulation BP, PR, SKIN PERFUSION- CAPILLARY REFILL, MENTAL STATUS, URINE FLOW The most common cause of shock in trauma is hemorrhage:
– two venous lines – Obtain blood for cross-matching, FBC, ABG, basic biochemistries

CIRCULATION
CARDIAC SHOCK- due to cardiac tamponade or tension pneumothorax
– Prominent jugular venous distension – Cool skin, pale, hypoperfused

NEUROGENIC SHOCK following a spinal cord injury
– Paraplegia, quadriplegia – Warm skin, absence of rectal tonus

DISABILITY
Repeatedly GCS Pts. who
– cannot follow a simple “ touch your nose” – gross asymmetry of limb motion and pupils Should be suspected of neurologic injuryEmergent brain CT SCAN

EXPOSURE
Visual inspection of the entire patient Inspect the back- logrolling the pt. Inspect the perineum

RESUSCITATION
Monitoring: ECG, BP, UO, PVC, CO, PO To assess the progress of resuscitation

SECONDARY SURVEY
HEAD NECK THORAX ABDOMEN LIMBS

HEAD
LACERATIONS STEP-OFFS GCS PUPILS CT

NECK
HARD NECK COLLAR SPINE X RAY LOCAL TENDERNESS HEMATOMAS SUBCUTANEOUS EMPHYSEMA

THORAX
LACERATIONS, WOUNDS SUBCUT. EMPHYSEMA CHEST MOTION BRUISING FLAIL CHEST BS

THORAX
CARDIAC TAMPONADE NECK VEINS HEART SOUNDS ECHOCARDIOGRAPHY PULMONARY CONTUSIONVENTILATION/PERFUSION MISMATCH

Life threatening condition

ABDOMEN
BLUNT TRAUMA:
– Hemorrhagic abdomen- internal bleeding – Peritonitic abdomen

WOUNDS:
– Penetrating – Perforating

Fracture of the pelvic bones

External fixation of the pelvis