MULTIPLE INJURIES
MULTIPLE INJURIES
Terminology:
Injury = the result of harmful event that
arieses from the release of specific forms of energy.
Multiple injuries = Polytrauma = injury of
two or more systems, one or the ombination imperil vital signs.
Trauma deaths
FIRST PEAK Within minutes of injury Due to major neurological or vascular injury Medical treatment can rarely improve outcome SECOND PEAK Occurs during the 'golden hour' Due to intracranial haematoma, major thoracic or abdominal injury Provide advanced trauma life support THIRD PEAK Occurs after days or weeks Due to sepsis and multiple organ failure
Assessment of the INJURED PATIENT
Primary survey and resuscitation
A = Airway and cervical spine
B = Breathing C = Circulation and haemorrhage control D = Dysfunction of the central nervous system E = Exposure
Secondary survey Definitive treatment
AIRWAY
Asses for obstruction , tracheal injuries, deviated tracheal
etc
Apply cervical collar to immobilize neck and prevent further
injury
Open airway by doing jaw thrust maneuver
Open mouth, remove the obstruction or secretion Do suction to remove any obstruction eg;secretion,blood or
any foreign body
Insert orophryngeal or nasopharyngeal airway to maintain
patency of airway.
Breathing
Check for spontaneous breathing for 10 sec by look listen and feel. Check for:
- rate - depth - use of accessory muscle at neck and abdomen to breath - sign of resp.distress: wheezing, crowing, gurgling
Circulation and haemorrhage control
Assess pulse, capillary return and state of
neck veins
Identify exsanguinating haemorrhage and
apply direct pressure
Give intravenous fluids (crystalloid or
colloid)
Attach patient to ECG monitor
Dysfunction / disability
Assess level of consciousness using AVPU
method A = alert V = responding to voice P = responding to pain U = unresponsive
Assess level of consciousness by performing
GCS
Assess pupil size, equality and responsiveness
EXPOSURE
from HEAD to TOE Check any other injury by doing head to toe
examination to detect any injury like deformity, laceration, abnormal movement of the body
If limb injury present immobilize:
Use RICE technique
R I C E-
Rest the patient Ice Compression Elevation.