BASIC CLINICAL SKILLS

IN TRAUMA
MADE AGUS DWIANTHARA SUETA
INTRODUCTION

 TRIAGE
 GREEN
 TRAUMA  DEATH
 YELLOW
 PRE-HOSPITAL
 RED
 HOSPITAL
 BLACK
MANAGEMENT OF TRAUMA

 HISTORY TAKING, MODE OF INJURY

 PRIMARY SURVEY
 ACTION (RESCUCITATION) & RE-EVALUATION
 ADJUNCTS TO PRIMARY SURVEY
 ACTION
 SECONDARY SURVEY
 ADJUNCTS TO SECONDARY SURVEY
 DEFINITIVE CARE
PRIMARY SURVEY

 AIRWAY + C-SPINE PROTECTION

 BREATHING
 CIRCULATION
 DISABILITY
 EXPOSURE
AIRWAY + C-SPINE PROTECTION

 OBSTRUCTION :
 FOREIGN BODIES  CHOKING
 SOFT PALATE/TONGUE  SNORNG
 INHALATION TRAUMA  STRIDOR, HOARSENESS
 FACIAL FRACTURES  STRIDOR, GURGLING
 FLUID (BLOOD, VOMIT)  GURGLING
AIRWAY + C-SPINE PROTECTION

WHAT TO DO ?
 CHIN LIFT
 JAW THRUST
 SUCTION
 OROPHARYNGEAL/NASOPHARYNGEAL TUBE
 LMA
 ETT
 CRICOTHYROTOMY
 TRACHESOSTOMY
BREATHING

 INSPECTION
 RR, CHEST MOVEMENT, PARADOXAL MOVEMENT, INTERCOSTAL INDRAWING, OPEN CHEST INJURY
 AUSCULTATION
 BREATH SOUND : VESICULAR, WHEEZING, RONCHI, CRACKLES/RALES, STRIDOR
 PALPATION
 TRACHEAL DEVIATION, PAIN, CREPITATION, TACTILE FREMITUS, RESPIRATORY EXPANSION
 PERCUSSION
 DULLNESS, HYPERSONOR/SONOR
BREATHING

LIFE THREATENING PROBLEMS THAT MAY

OCCUR IN TRAUMA :
WHAT TO DO ?
 PNEUMOTHORAX
 BAG & MASK VENTILATION
 TENSION PNEUMOTHORAX
 NEEDLE THORACOCENTESIS
 HEMATOTHORAX
 CHEST TUBE INTUBATION
 FLAIL CHEST
 PERICARDIOCENTESIS
 PULMONARY CONTUSION
 CARDIAC TAMPONADE
CIRCULATION & HEMORRHAGE
CONTROL

 CHECK FOR :
 VITAL SIGNS
 BLOOD PRESSURE
 PULSE
 PHYSICAL EXAMINATION :
 CAPILLARY REFILL TIME
 PALE & COLD SKIN?
 ASSESS FOR :
 SHOCK  GRADE I-IV
 EXTERNAL BLEEDING
 OCCULT BLEEDING
ABDOMINAL EXAMINATION
 I : DISTENTION? MASSES? SCARS?
LESIONS?
 A: DECREASED BOWEL SOUND?
 P: PAIN? TENDERNESS? RIGIDITY? MUSCLE
GUARDING?
 P: PAIN? DULLNESS?
CIRCULATION & HEMORRHAGE
CONTROL

WHAT TO DO?
 RESCUSCITATION  IV LINE & SUPPLEMENTAL OXYGEN
 CRYSTALLOIDS & COLLOIDS INFUSION
 BLOOD TRANSFUSION  IF NECESSARY
 URINARY CATHETER  URINARY OUTPUT?
 ABDOMINAL EXAM : MUSCLES GUARDING (+) / RIGIDITY (+) / ABD PAIN (+) WITH
UNRESPONSIVE (HYPOVOLEMIC) SHOCK  SURGICAL RESCUCITATION
DISABILITY & EXPOSURE

DISABILITY

EXPOSURE
 AVPU :
 A : ALERT
 V : RESPOND TO VOCAL STIMULI  EXAMINES THE WHOLE BODY WITHOUT
ANY CLOTHES
 P : RESPOND TO PAINFUL STIMULI
 U : UNRESPONSIVE
ADJUNCTS TO PRIMARY SURVEY

 VITAL SIGNS
 GCS
 URINARY OUTPUT
 DIAGNOSIC TOOLS
 CXR, C-SPINE, PELVIS
 FAST
 DPL
 SECONDARY SURVEY

 HISTORY TAKING :
 AMPLE
 MOI
 PHYSICAL EXAMINATION
 HEAD & SKULL  DIAGNOSTIC TOOLS
 MAXILLOFACIAL  X-RAYS
 NECK  LAB TESTS
 CHEST & SPINE  OTHER SPECIAL STUDIES
 ABDOMEN
 GENITAL
 EXTREMITIES
 RT
DEFINITIVE CARE

 COMPREHENSIVE TREATMENT OF ALL INJURY

 FRACTURE STABILISATION
 NECESSARY OPERATIVE INTERVENTION
 APPROPRIATE INTENSIVE CARE
 REHABILITATION
 STABILISATION & APPROPRIATE TRANSFER
THANK YOU