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Potentially Life
Threatening Injuries.
What is Trauma?
• Causes:
• Causes:
-Sepsis
-Organ Failure
-Missed Injuries
Initial Assessment
• Primary Survey
• Secondary Survey
Primary Survey.
• Preliminary assesment in a systemic manner.
• Assess and address life threatening injuries in order and manage them as soon as they
are found.
• 10 seconds assessment.
• Primary survey and resuscitation of vital funtions are done simultaneously.
• Primary survey covers the ABCDE to identifies life-threatening conditions by
adhering to this sequence.
• Primary survey In Pre-hospital Phase (DR)ABCDE.
Airway & Cervical Spine Protection.
• Ascertain patency (look,listen and feel).
• If patient is able to communicate well, the airway is not likely to be immediate jeopardy.
• Establish a definitive airway if there is any doubt about the patient’s ability to maintain
airway integrity.
• PALPATION: to assess for tracheal deviation, chest wall, s/c emphysema, signs of deformity.
• Motor function.
Exposure
• Exposure facilitates thorough examination and assessment
• Prevention of hypothermia
• Performed after Primary survey and the patient is resusitated and stable.
• Aims to detect other significant but not immidiate life threatening injury, to reduce
missing of failling investigation to patient’s injury.
History
AMPLE accronym are use for history taking.
• Allergies
• Medications
• Past medical hx
• Last meal
Management:
• assume cervical spine injury in head trauma or maxilofacial injusires and cervical motion
must be restricted.
• perform IPPA ix, look for subcutaneous emphysema, tracheal deviation and jvp
distention.
Chest examinations.
• Visual evaluation of the anterior and posterior to identify conditions such as open
pneumothorax and large flail segments.
• Palpations over the entire chest cage including the clavilcles, ribs,and sternum.
• Assess extremities using CCTVR. Ensure DPA, PTA, Radial & Bracheal pulse are palpable.
• Body tenderness and deformity along the entire length of the spine and sacroiliac joint of pelvic.
( perform logroll prior examination)
Posterior, Perineal and Rectal.
• Perform logroll
• Perinial=see if any blood at the urethal meatus, scrotal bruising and hematoma, Perineal bruising,
wounds and tears.
• ensure anal spincter tone, perinial sensation, bowel wall integrity, bony fragments from pelvic,prostate
position and rectal bleeding.
LIFE THREARTENING
INJURIES
ATOM TC
• Airway obstruction
• Tension Pneumothorax
• Open Pneumothorax
• Massive Haemothorax
• Tracheobronchial Injury
• Cardiac Temponade.
Airway Obstruction.
• Control of airway is the foremost in trauma
• Protect the cervical spine as the airway is being managed (in line
immobilization)
- Laryngeal trauma
Management:
1. Immediate Needle
Thoracocentensis (temporary measure) – 2nd
ICS in the midclavicular line of affected
hemithorax.
• • During inspiration(anegativeintra-thoracicpressureis
generated) air enters into the chest cavity not through the
trachea but through the hole in the chest wall.
Management:
Signs & Symptoms:
• Seal the wound with a
• • Bubbling at wound site sterile occlusive dressing,
large enough to overlap
• • Dyspnoea and Tachypnoea the wounds edges
Possible Sources:
• Intercostalvessels
• Internalmammary artery
• Pulmonaryvessels
• Lungparenchyma
• Dullness to percussion
Managment:
• If patient is stable operative treatment may be delayed until the acute inflammation and
edema resolve.
Cardiac Temponade
1. Pulmonary Contusion
2. Myocardial Contusion
3. Aortic Disruption
5. Tracheobronchial Disruption
6. Esophageal Disruption
7. Simple Pneumothorax
8. Non-Massive haemothorax
REFERANCE
• ADVANCE TRAUMA LIFE SUPPORT Student course manual
• Oxford handbook of Acute Medicine, Third Edition, edited by Punit S. Ramrakha, Kevin P. Moore, Amir Sam.
• Participants Handouts PHCLS level 1, Updated 2020/2, Pre-Hospital Malaysia Training Unit.
• Guide to the essentials in Emergency Medicine 2nd Edition, Edited by Shirley Ooi and Peter Manning.
• Discussion with Mentor AMO Syaripuddin Daring & AMO Stefano Spencer T.
• Discussion with Senior AMO ETD QEH II: AMO Cheng Ming Ho & AMO JIhad Faruqiy
• Discussion with MO ETD Tuanku Ja’afar Hospital, Seremban: Dr. Annusha D/O Chandrasikran
THANK YOU !!