Trauma, multiple casualties
Polytrauma  Multisystem trauma <ul><li>Terminology: </li></ul><ul><li>Injury = the result of harmful event that arieses fr...
Trauma deaths <ul><li>First peak  </li></ul><ul><li>Within minutes of injury  </li></ul><ul><li>Due to major neurological ...
Assessment of the injured patient  <ul><li>Primary survey and resuscitation  </li></ul><ul><ul><li>A = Airway and cervical...
Airway and cervical spine <ul><li>Always assume that patient has cervical spine injury </li></ul><ul><li>If patient can ta...
Breathing <ul><li>Check position of trachea, respiratory rate and air entry </li></ul><ul><li>If clinical evidence of tens...
Circulation and haemorrhage control <ul><li>Assess pulse, capillary return and state of neck veins  </li></ul><ul><li>Iden...
Dysfunction <ul><li>Assess level of consciousness using AVPU method  A = alert  V = responding to voice  P = responding to...
Exposure <ul><li>Avoid hypothermia </li></ul><ul><li>Fully undress patients  </li></ul><ul><li>Avoid hypothermia </li></ul>
Multiple casualties <ul><li>several causalties at the same time . </li></ul><ul><li>1.  Alarm  ER services </li></ul><ul><...
Triage <ul><li>Ability to walk  </li></ul><ul><li>Airway  </li></ul><ul><li>Respiratory rate  </li></ul><ul><li>Pulse rate...
 
Road accidents <ul><li>fall from a bicycle …. major incident with many causalties. </li></ul><ul><li>serious risks to safe...
1. Make the area safe  <ul><li>protect yourself,  the causalty and other road users. </li></ul><ul><ul><li>Park your car s...
2. Check  all  caulsalties <ul><li>quick assess </li></ul><ul><li>no moving  </li></ul><ul><li>apply life-saving treatment...
3. Treat <ul><li>in the position found </li></ul><ul><li>first life-threatening or potentialy serious injuries </li></ul>
4. search all area
 
How to move unconscious casualty <ul><li>do not move  the casualty unless it is absolutely necessary </li></ul><ul><li>ass...
 
 
 
 
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08 polytrauma

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08 polytrauma

  1. 1. Trauma, multiple casualties
  2. 2. Polytrauma Multisystem trauma <ul><li>Terminology: </li></ul><ul><li>Injury = the result of harmful event that arieses from the release of specific forms of energy. </li></ul><ul><li>“polytrauma” = Multisystem trauma = injury of two or more systems, one or the combination imperil vital signs . </li></ul>
  3. 3. Trauma deaths <ul><li>First peak </li></ul><ul><li>Within minutes of injury </li></ul><ul><li>Due to major neurological or vascular injury </li></ul><ul><li>Medical treatment can rarely improve outcome </li></ul><ul><li>Second peak </li></ul><ul><li>Occurs during the 'golden hour' </li></ul><ul><li>Due to intracranial haematoma, major thoracic or abdominal injury </li></ul><ul><li>Primary focus of intervention for the Advanced Trauma Life Support (ATLS) methodology </li></ul><ul><li>Third peak </li></ul><ul><li>Occurs after days or weeks </li></ul><ul><li>Due to sepsis and multiple organ failure </li></ul>
  4. 4. Assessment of the injured patient <ul><li>Primary survey and resuscitation </li></ul><ul><ul><li>A = Airway and cervical spine </li></ul></ul><ul><ul><li>B = Breathing </li></ul></ul><ul><ul><li>C = Circulation and haemorrhage control </li></ul></ul><ul><ul><li>D = Dysfunction of the central nervous system </li></ul></ul><ul><ul><li>E = Exposure </li></ul></ul><ul><li>Secondary survey </li></ul><ul><li>Definitive treatment </li></ul><ul><li>Call for help ER 155 </li></ul>
  5. 5. Airway and cervical spine <ul><li>Always assume that patient has cervical spine injury </li></ul><ul><li>If patient can talk then he is able to maintain own airway </li></ul><ul><li>If airway compromised initially attempt a chin lift and clear airway of foreign bodies </li></ul><ul><li>Intubate or cricothyroidotomy </li></ul><ul><li>Give 100% Oxygen </li></ul>
  6. 6. Breathing <ul><li>Check position of trachea, respiratory rate and air entry </li></ul><ul><li>If clinical evidence of tension pneumothorax will need immediate relief </li></ul><ul><li>Place venous cannula through second intercostal space in the mid-clavicular line </li></ul><ul><li>If open chest wound seal with occlusive dressing </li></ul>
  7. 7. Circulation and haemorrhage control <ul><li>Assess pulse, capillary return and state of neck veins </li></ul><ul><li>Identify exsanguinating haemorrhage and apply direct pressure </li></ul><ul><li>Place two large calibre intravenous cannulas Give intravenous fluids ( c rystalloid or colloid) </li></ul><ul><li>Attach patient to ECG monitor </li></ul>
  8. 8. Dysfunction <ul><li>Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive </li></ul><ul><li>Assess pupil size, equality and responsiveness </li></ul>
  9. 9. Exposure <ul><li>Avoid hypothermia </li></ul><ul><li>Fully undress patients </li></ul><ul><li>Avoid hypothermia </li></ul>
  10. 10. Multiple casualties <ul><li>several causalties at the same time . </li></ul><ul><li>1. Alarm ER services </li></ul><ul><li>2. Assess the scene - without puting your safety at risk. </li></ul><ul><li>3. Triage 'do the most for the most' </li></ul>
  11. 11. Triage <ul><li>Ability to walk </li></ul><ul><li>Airway </li></ul><ul><li>Respiratory rate </li></ul><ul><li>Pulse rate or capillary return </li></ul>
  12. 13. Road accidents <ul><li>fall from a bicycle …. major incident with many causalties. </li></ul><ul><li>serious risks to safety - traffic </li></ul>
  13. 14. 1. Make the area safe <ul><li>protect yourself, the causalty and other road users. </li></ul><ul><ul><li>Park your car safely, turn lights on, set hazard lights flashing. </li></ul></ul><ul><ul><li>Do not across a bussy motorway to reach other side </li></ul></ul><ul><ul><li>Set others to warn other comming drivers </li></ul></ul><ul><ul><li>Set up warning triangles or lights 200 metres in each direction. </li></ul></ul><ul><li>Swich off ignition of any damaged vehicle. </li></ul><ul><li>Is anyone smoking? </li></ul>
  14. 15. 2. Check all caulsalties <ul><li>quick assess </li></ul><ul><li>no moving </li></ul><ul><li>apply life-saving treatment </li></ul>
  15. 16. 3. Treat <ul><li>in the position found </li></ul><ul><li>first life-threatening or potentialy serious injuries </li></ul>
  16. 17. 4. search all area
  17. 19. How to move unconscious casualty <ul><li>do not move the casualty unless it is absolutely necessary </li></ul><ul><li>assume neck injury until proved otherwise </li></ul><ul><ul><li>support head and neck with your hands, so he can breathe freely Apply a collar, if possible </li></ul></ul><ul><ul><li>There should be only 1 axis (head, neck, thorax) no moving to sides, no flexion, no extension. </li></ul></ul><ul><ul><li>with other 3-4 people 1 support head (he is directing others), other one shoulders and chest, other one hips and abdomen, last one - legs. </li></ul></ul>

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