Emergency
Trauma Care
Dr Febian Aji Wicaksono, Sp.B
Goals of the EMERGENCY TRAUMA CARE
• Provide medicale personnel with a standardized systemic approach to
caring for trauma victims
• Encompass the care needed for both major and minor trauma
• Decrease morbidity and mortality rates in trauma victims
Basic sequence of trauma care
• Rapid primary assessment of the patient
• Start resuscitative
• Complete a secondary assessment
• Determine if the patient needs emergent surgery or transfer to
another medical facility for specialized or advanced care
• Defenitive care
• Rehabilitation
Why is trauma care important
• Trauma is the leading cause of
death in the first four decades of life
• WHO and CDC, more than 9 people
die every minute from injuries or
violence
• Injury-related deaths are expected
to rise dramatically by 2020, and
deaths due to motor vehicle crashes
are projected to increase by 80%
from current rates in low- and
middle-income countries.
Data from Global Burden of Disease, 2004. Reproduced with
permission from Injuries and Violence: The Facts. Geneva: World
Health Organization Department of Injuries and Violence
Prevention; 2010.
INITIAL ASSESMENT AND
MANAGEMENT
What do you think ?
Trimodal Death Distribution
Sepsis and multiple organ
The third peak system dysfunctions
The second Multiple other injuries
associated with significant
peak blood loss
Apnea due to severe brain or
high spinal cord injury or
The first peak rupture of the heart, aorta, or
other large blood vessels.
Initial Assessment and
Management The “initial assessment,” includes the
following elements:
When treating injured patients, • Preparation
clinicians rapidly assess injuries and • Triage
institute life- preserving therapy. • Primary survey (ABCDEs) with
immediate resuscitation of patients
Because timing is crucial, a systematic with life-threatening injuries
approach that can be rapidly and • Adjuncts to the primary survey and
accurately applied is essential resuscitation
• Patient transfer
• Secondary survey (head-to-toe
evaluation and patient history)
• Continued post resuscitation
monitoring and reevaluation
• Definitive care
Preparation
Coordinated with
Prehospital phase the clinicians at the
receiving hospital
Trauma patients
occurs in two
different clinical
settings: in the field
and in the hospital
Trauma patient
Hospital phase
resuscitation.
Prehospital Phase
Coordination of EMS with hospital
physician before the patient transport
from the scene
• Time injury
• Mechanism of injury
• Patient history
Airway maintenance
Control of external bleeding and shock
Immobilization of the patient
Immediate transport to the closest
appropriate facility
Preferably a verified trauma center
Hospital Phase
A resuscitation area is available for
trauma patients.
Properly functioning airway equipment
(e.g., laryngoscopes and endotracheal
tubes)
Warmed intravenous crystalloid solutions
are immediately available for infusion, as
are appropriate monitoring devices.
Ensure prompt responses by laboratory
and radiology personnel.
Transfer agreements with verified trauma
centers are established and operational.
TRIAGE
Treatment priority include the severity of
injury, ability to survive, and available
resources.
Multiple Casualties Mass Casualties
Field Triage Decision Scheme
proximal
Primary Survey With Simultaneous Resuscitation
Airway maintenance with restriction of cervical spine motion secon
10
d
assess
Breathing and ventilation ment
Circulation with hemorrhage control
Disability(assessment of neurologic status)
Exposure/Environmental control
Airway Maintenance With Restriction Of Cervical
Spine Motion
• Establish a definitive airway if there
is any doubt about the patient’s
ability to maintain airway integrity.
• While assessing and managing a
patient’s airway, take great care to
prevent excessive movement of the
cervical spine. Based on the
mechanism of trauma, assume that When the cervical collar is removed, a member
a spinal injury exists. of the trauma team manually stabilizes the
patient’s head and neck.
Breathing And Ventilation
Clinicians must rapidly examine and evaluate each component ventilation
function.
Airway obstruction or disruption
Tension pneumothorax
Inspection Open pneumothorax
Massive haemothorax
Flail chest
Palpation Cardiac tamponade
Percussion Aortic injury
Thorax injuries (non-massive hemothorax, simple
pneumothorax)
Oesphageal perforation
Auscultation Muscular diaphragmatic injury (a stretch this one, I know)
Fistula (bronchopleural) and other tracheobronchial injury
Contusion to the heart or lungs
Circulation With Hemorrhage Control
Blood Volume and Cardiac Bleeding
Output Identify the source of
Level of Conciousness bleeding as external or
internal
Skin Perfusion
Definitive bleeding control is
Pulse essential, along with
appropriate replacement of
intravascular volume.
Aggressive and continued
volume resuscitation is not a
substitute for definitive
control of hemorrhage.
Disability (Neurologic Evaluation)
The GCS is a quick, simple, and
objective method of
determining the level of
consciousness
Exposure And Environmental Control
Adjuncts During The Primary Survey
• Electrocardiographic Monitoring
• Pulse Oximetry
• Assessment Of Ventilatory Rate, And Arterial Blood Gas
(ABG)
• Urinary Catheters And Gastric Tube
• Focused Assessment With Sonography For Trauma (FAST),
And DPL.
Secondary Survey
The secondary survey does not begin until the
primary survey (ABCDE) is completed
Mechanisms Of Injury And Suspected Injury Patterns
• To perform effectively, each trauma
team should have one member
serving as the team leader.
• The team leader supervises
• Checks
• Directs the assessment
The following are some of the possible
roles, depending on the size and
composition of the team:
• Assessing the patient, including airway
assessment and management
• Undressing and exposing the patient
• Applying monitoring equipment
• Obtaining intravenous access and drawing
blood
• Serving as scribe or recorder of
resuscitation activity
immediate life-
threatening conditions
• Mechanism (and time)
of injury
• Injuries found and
suspected
• Symptoms and Signs
• Treatment initiated
