MULTPLE TRAUMA THORAX

CARDIOVASCULAR

Definitive Surgery for Trauma and Acute Care Surgery

The College of Surgeons of Indonesia
First Edition, 2019

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 MULTITRAUMA

KOLEGIUM ILMU BEDAH INDONESIA

DSTC IKATAN AHLI BEDAH INDONESIA

DEFINITIVE SURGICAL TRAUMA CARE

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 Case

M : 16th years old, fell down from the express train

I : Air way clear
- Traumatic amputation on right above (elbow & knee)
- Bruising on the right chest
S : - T:90/60, N:110/n, RR: 35/m
T : non
Arrival to the hospital 30 minutes after the accident. At that time
you are on duty as surgeon Chief Resident.
The ED team consist of 3 GP’s and 5 Nurses
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1. What is the problem do you have in the patient?
2. What is the life threatening for the patient?
3. What are the next step to do?

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AJUNCT TO PRIMARY
SURVEY

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 OBJECTIVE

• After the interactive discusion you are be able to manage the

multi trauma patient promptly
1. Able to apply the ATLS principle for multi trauma patient
2. Which one of the priority in the primary survey
3. Evaluate your management

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 DISCUSION QUESTION

M : 16th years old, fell down from

1. What are the immediate life treating in the the express train
patient?
I : Air way clear
- Traumatic amputation on
right above elbow & knee
Case scene progression - Brusing on the right chest

- Scene on ED S : - T:90/60, N:110/n, RR: 35/m

Patient agitated, panic, and short of breathing T : non
- 02 Sat 88%
- Hb 8

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 DISCUSION QUESTION

1. What is the most likely Case scene progression

-Scene on ED
diagnosis? Patient agitated, panic, and
short of breathing
-02 Sat 88%
-Hb 8
2. What is the approxiate
technique to alleviate the
patient condition?

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 CASE PROGRESSION

• IL OF IV Fluid given
• Vital sign : BP 100/10, HR : 100, RR : 28/M
• O2 Sat 90% on non rebreating mask

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 DISCUSION QUESTION

1. Wich the following emergency incision for the patient

a. AnteroLateral
b. Postero Lateral
c. Clamp Shell
d. Hemi Clamp Shell

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 DISCUSION QUESTION

1. During the exploration there was a pool of blood (damage all

the right lobi).

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 DISCUSION QUESTION

1. Which the following instrument available to stop the bleeding

in emergency situation (You don’t have Vascular Clamp)
a. Ellis Clamp
b.Anatomy clamp
c. Surgical clamp
d.Intestinal-Intestinal clamp

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• The traumatic amputation being well after stomp
reconstruction
• He does well and stay in the ward 4 days after

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?
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 OBJECTIVES

To discuss:

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SUMMARY

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THANK YOU

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