MANAGEMENT OF

MULTIPLE TRAUMA.

DR. D. V. KANISHKA KAMAL

Where should we start ? ?
 DEATH FOLLOWING
INJURY

SHOWS A DISTINCT TRIMODAL PATTERN.

DR. DONALD TRUNKEY
CHAIRMAN OF DEPT. OF SURGERY
OREGAN, USA.

IMMEDIATE DEATHS - 50% - within minutes

EARLY DEATHS - 30% - 1-3 hours
LATE DEATHS - 20% - 2-4 weeks

* CONCEPT OF GOLDEN HOURS OF TRAUMA !

 HISTORY

1970- DR. JAMES STYNER

AMERICAN ORTHOPAEDIC SURGEON

INTRODUCED A STRUCTURED TRAUMA

MANAGEMENT TRAINING PROGRAMME

AMERICAN COLLEGE OF SURGEONS

DEVELOPED ATLS EDUCATIONAL PACKAGE.
.
 PHILOSOPHY

TREAT LETHAL INJURY FIRST,

THEN REASSESS,

AND TREAT AGAIN !

 ATLS COMPONENT STEPS
1. PRIMARY SURVEY
- IDENTIFY WHAT IS KILLING THE PATIENT.

2. RESUSCITATION
- TREAT WHAT IS KILLING THE PATIENT.

3. SECONDARY SURVEY
- PROCEED TO IDENTIFY ALL OTHR INJURIES.

4. DEFINITIVE CARE
- DEVELOP A DEFINITIVE MANAGEMENT
PLAN.
 PRIMARY SURVEY

SURVEY OF….

1. AIRWAY WITH CERVICAL SPINAL CONTROL

2. BREATHING AND VENTILATION
3. CIRCULATION WITH CONTROL OF HAEMORRHAGE
4. DYSFUNCTION OF THE CNS
5. EXPOSURE IN A CONTROLLED ENVIRONMENT
AIRWAY OBSTRUCTION KILLS IMMEDIATELY !

SECURING AIRWAY WITH

CERVICAL SPINAL CONTROL

CONTROL CERVICAL SPINE

MANUAL INLINE CONTROL
COLLAR/ SAND BAG/ HEAD TAPE

ASSESS AIRWAY

AIRWAY MANAGEMENT
 AIRWAY MANAGEMENT
1. CONTROL CERVICAL SPINE
MANUAL INLINE CONTROL
COLLAR/ SAND BAG/ HEAD TAPE

2. CLEAR AIRWAY
TWO FINGER SWEEP
SUCTION
3. MAINTAIN AIRWAY
CHIN LIFT / JAW THRUST

4. PROVIDE AIRWAY
AIRWAY DEVICES
CRICOTHYROIDOTOMY
5. O2 – 14 L / MINUTE
 BREATHING AND
VENTILATION
ASSESS - TO IDENTIFY
IMMEDIATELY LIFE THREATENING
CONDITIONS

1. TENSION PNEUMOTHORAX
2. MASSIVE HAEMOTHORAX
3. OPEN PNEUMOTHORAX
4. FLAIL CHEST
Open pneumothorax
Tension pneumothorax
Haemothorax
Flail chest
PROBLEMS IN CIRCULATION

SHOCK.
Hypovolaemic, cardiogenic

Cardiac tamponade leading to

shock.
CIRCULATION AND CONTROL OF
HAEMORRHAGE

ASSESSMENT FOR SIGNS OF SHOCK

CAUSE OF SHOCK

ASSESS THE DEGREE OF BLOOD LOSS

CLASS I, II, III, IV

SITE OF BLOOD LOSS

“ Blood on the floor and four more “
 MANAGEMNT OF
A PATIENT IN SHOCK
VASCULAR ACCESS
PERIPHERAL VENOUS CANNULATION
VENOUS CUTDOWN
INTRAOSSEOUS TRANSFUSION

DRAW BLOOD FOR GROUPING & DT AT THE

SAME TIME,

RESUSCITATION
TRANSFUSE 2L OF HARTMAAN SOLN.

ASSESS RESPONSE
IMMEDIATE AND SUSTAINED
TRANSIENT & LATER DETERIORATION
NO RESPONSE
DYSFUNCTION OF THE CNS

ASSESSMENT OF NEUROLOGICAL STATUS

AVPU – ALERT
RESPONDS TO VOICE
RESPONDS TO PAIN
UNRESPONSIVE
 MONITORING

PULSE OXYMETER
BLOOD PRESSURE & HEART RATE
ECG
URINE OUTPUT
TEMPERATURE
INVESTIGATIONS DURING
INITIAL STAGE

XRAY CERVICAL SPINE – LATERAL FILM

XRAY CHEST – SUPINE PA
XRAY PELVIS - AP
 HISTORY

1. ALLERGIES
2. MEDICATIONS
3. PAST MEDICAL HISTORY
4. LAST MEAL
5. EVENT LEADING TO THE INJURY
EXPOSURE OF THE PATIENT

EXPOSE IN A CONTROLLED
ENVIRONMENT!
 FURTHER DECISION
MAKING
RESPONSE TO PRIMARY SURVEY AND
RESUSCITATION INFLUENCES FURTHER
DECISION MAKING

1. NO LIFE THREATENING CONDITION

2. SUSTAINED RESPONSE
3. TRANSIENT RESPONSE
4. NO RESPONSE
 SECONDARY SURVEY

HEAD TO TOE EXAMINATION

HEAD, FACE, NECK, THORAX ,
ABDOMEN, PELVIS, SPINAL INJURIES,
EXTREMITIES

VITAL SIGNS MONITORING DEVICES ARE IN SITU

DETAILED RADIOGRAPHIC PROCEDURES

POTENTIALLY LIFE THREATNING
INJURIES
- SECONDARY SURVEY

1. PULMONARY CONTUSION
2. MYOCARDIAL CONTUSIONS
3. AORTIC TEAR
4. DIAPHRAGMATIC TEAR
5. OESOPHAGEAL TEAR
6. TRACHEOBRONCHIAL TEAR
DEFINITIVE CARE PLAN

DECISION ON OWNERSHIP

ATTENTION OF THE OTHER SPECIALISTS

THANK YOU !