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  • Dr. PriteshVyas

Transcript

  • 1. Pre-Hospital Management Sudden Collapsed Patient Trauma Dr. Pritesh Vyas M.D. (Anesthesia) Consultant Anesthetist & Intensivist
  • 2. Causes of Sudden Collapse • Head Injury / Major Trauma • Massive Intracranial Event • Infarct • Hemorrhage • Major Myocardial Infarction • Pulmonary Embolism • Poisoning • Oral / Inhaled / Injected • Insect / Snake Bite • Chocking • Convulsion Dr. Pritesh Vyas (M.D.)
  • 3. History & Clinical Examination Brief history is important, do not waste more time Ask for • Current event • Past / Present Other Major Illness • Duration of Collapse / Unconsciousness Look for • Level of Consciousness • Airway • Breathing • Pulse • Cardiac Activity Dr. Pritesh Vyas (M.D.)
  • 4. The Chain of Survival American Heart Association (AHA) first proposed the phrase quot;the chain of survival” • rapid access to medical care • early basic life support (BLS) • early defibrillation and • early advanced cardiac life support (ACLS). Dr. Pritesh Vyas (M.D.)
  • 5. Check Responsiveness Dr. Pritesh Vyas (M.D.)
  • 6. „ABCD of Resuscitation‟ A. Airway B. Breathing C. Circulation D. Defibrilation Dr. Pritesh Vyas (M.D.)
  • 7. Causes of Airway Obstruction Dr. Pritesh Vyas (M.D.)
  • 8. Adult Foreign Body Airway Obstruction Dr. Pritesh Vyas (M.D.)
  • 9. Back Blow in Chocking Dr. Pritesh Vyas (M.D.)
  • 10. Abdominal Thrust in CONSCIOUS Patient (Heimlich maneuver) Dr. Pritesh Vyas (M.D.)
  • 11. Unconscious? SHOUT FOR HELP • CPR is always best done with more then one persons CALL AMBULANCE “108” • Early initiation of ACLS • Better infrastructure • Expert help Dr. Pritesh Vyas (M.D.)
  • 12. Airway Assessment “ Look, Listen & Feel” Dr. Pritesh Vyas (M.D.)
  • 13. Head Tilt & Jaw Lift Dr. Pritesh Vyas (M.D.)
  • 14. Jaw Thrust Dr. Pritesh Vyas (M.D.)
  • 15. Expired Air Resuscitation Dr. Pritesh Vyas (M.D.)
  • 16. Landmarks for Chest Compression Dr. Pritesh Vyas (M.D.)
  • 17. Position During Chest Compression Dr. Pritesh Vyas (M.D.)
  • 18. Assessment Dr. Pritesh Vyas (M.D.)
  • 19. Recovery Position Dr. Pritesh Vyas (M.D.)
  • 20. Recovery Position Dr. Pritesh Vyas (M.D.)
  • 21. AMBU (Artificial Mobile Breathing Unit) Dr. Pritesh Vyas (M.D.)
  • 22. Laryngoscope Dr. Pritesh Vyas (M.D.)
  • 23. Oropharyngeal Airway Dr. Pritesh Vyas (M.D.)
  • 24. Nasopharyngeal Airway Dr. Pritesh Vyas (M.D.)
  • 25. LMA (Laryngeal mask Airway) Dr. Pritesh Vyas (M.D.)
  • 26. Dr. Pritesh Vyas (M.D.)
  • 27. Dr. Pritesh Vyas (M.D.)
  • 28. Dr. Pritesh Vyas (M.D.)
  • 29. Further Management • Intravenous access with large bore (20G, 18G) cannula • Treat precepitating factor • Manage Transfer • Provide Supplemental Oxygen and IV fluids Dr. Pritesh Vyas (M.D.)
  • 30. List of necessary things • Telephone • Torch • Stethoscope • AMBU • Oral / Nasal Airway • 18 G, 20 G IV cannula • IV set, Disposible Syringes • IV fluids Dr. Pritesh Vyas (M.D.)
  • 31. Additional Facilities • Laryngoscope & Endotracheal Tube / LMA • Oxygen Cylinder • Sucction Machine • ECG Monitor with Defibrillator / AED • Pulseoxymeter / Multipara Monitor Dr. Pritesh Vyas (M.D.)
  • 32. Pre-hospital Management of Trauma Dr. Pritesh Vyas (M.D.)
  • 33. What will you do? Dr. Pritesh Vyas (M.D.)
  • 34. Triage The word triage derives from the French word meaning “to sort.” When applied in a medical context, triage involves the initial evaluation of a casualty and the determination of the priority and level of medical care necessary for the victim. The purpose of triage is to be selective, so that limited medical resources are allocated to patients who will receive the most benefit Dr. Pritesh Vyas (M.D.)
  • 35. Triage Critaria • Glasgow Coma Scale of 13 or less • Systolic blood pressure of 90 or less • Respiratory rate of 10 per minute or less, or greater than 29 per m • Sustained pulse rate of 120 per m or more • Head trauma with altered state of consciousness, hemiplegia, or uneven pupils • Penetrating injuries of the head, neck, torso, and limbs proximal to the elbow or knee • Chest trauma with respiratory distress or signs of shock • Pelvic Fractures OR Two or more proximal long bone fractures • Amputations above the wrist or ankle • Limb Paralysis • Combination of trauma with burns • Mechanism of Injury and High Energy Impact like • Fall of 20 feet or more • Patient struck by a vehicle moving 20 MPH or more • Patient ejected from a vehicle • Vehicle rollover with the patient unrestrained • High speed crash (initial speed of >40 MPH) with 20 inches of major front end deformity, 12 inches or more deformity into the passenger compartment • Patient was a survivor of a MVA where a death occurred in the same vehicle Dr. Pritesh Vyas (M.D.)
  • 36. Other Criteria • Age of less than 5 years old, or over 55 years old • History of cardiac disease, respiratory disease, insulin dependent diabetes, cirrhosis, or morbid obesity • Pregnancy • Immunosuppressed patients • Patients with bleeding disorders, or patients on anticoagulants • Burns of greater than 30% of body surface area in adults, or 15% body surface area in children • Burns of the head, hands, feet, or genital area • Inhalation injuries • Electrical burns • Burns associated with multiple trauma or severe medical problems Dr. Pritesh Vyas (M.D.)
  • 37. Glasgow Coma Scale Feature Response Score Eye Opening Spontaneous 4 To speech 3 To pain 2 None 1 Vrebal Response Oriented 5 Confused conversation 4 Words inappropriate 3 Sounds incomprehensible 2 None 1 Best Motor Response Obeys commands 6 Localizes pain 5 Flexion normal 4 Flexion abnormal 3 Extended 2 None 1 Dr. Pritesh Vyas (M.D.)
  • 38. ABCDE of Trauma Management A. Airway maintenance with cervical spine protection B. Breathing and ventilation C. Circulation with hemorrhage control D. Disability; neurologic status E. Exposure/Environment (completely undress the patient and prevent hypothermia) Dr. Pritesh Vyas (M.D.)
  • 39. Initial Evaluation of Trauma • Level of consciousness • History • Clinical Examination • Haemostasis • Immobilization • Supplemental Oxygen if needed • IV Fluids • Analgesics, Antibiotics Dr. Pritesh Vyas (M.D.)
  • 40. Level of Consciousness CONSCIOUS UNCONSCIOUS Follow further line of trauma Check for need of CPR management • YES – Start CPR first AMPLE Survey • NO • Allergies • Secure Airway • Medications currently being taken by the patient • Check Vital Signs • Past illness and operations • Not Good ? - Correct first • Last meal • Events and Environment • Good? - Follow related to the injury further line of trauma management Dr. Pritesh Vyas (M.D.)
  • 41. History • Time of Trauma • Mode of injury • Change in level of consciousness • Amount of blood loss • Pregnancy – if female • Other pre-existing medical disorders • Drug history • Medicine • Intoxication – drugs, alcohol, poisons Dr. Pritesh Vyas (M.D.)
  • 42. Clinical Examination • Level of consciousness • Vitals • General Examination from head to toe • Quick Systemic Examination • RS – Air Entry, Chest Movements, Chest Compression • CVS – S1, S2, Murmur, Rhythm • AS – Wounds, Bruises, Distention, Pelvic Compression • CNS – GCS, Orientation, Pupils, Limb Movements Dr. Pritesh Vyas (M.D.)
  • 43. Haemostasis Control any active visible bleeding with • Pressure • Bandage • Tourniquet • Pressure Points • Suture (if possible) Dr. Pritesh Vyas (M.D.)
  • 44. Key Points in Fracture Management • Never try to correct deformity yourself • Apply sterile dressing over open wound • Haemostasis • IMMOBILIZATION • Limbs – any solid slab • Neck – hard cervical collar Dr. Pritesh Vyas (M.D.)
  • 45. Supportive Treatment • Large bore IV line (18 G, 20 G) • IV Fluids • Analgesics • Wound Dressing • Antibiotics • Oxygen Support • Arrange safe transfer • Police Inform Dr. Pritesh Vyas (M.D.)
  • 46. Small but important lines • Never remove penetrating foreign body • If Female – ask about pregnancy • Secure IV line – Two lines better • X-Ray, CT Scan • Blood Samples – Lab. Tests • Cross-matching • Inform Refferal Hospital in advance with proper records – saves time • Reassessment Dr. Pritesh Vyas (M.D.)
  • 47. Critical Trauma Patient  Inadequate or threatened airway  Impaired ventilation as demonstrated by the following:  Abnormally fast or slow ventilatory rate  Hypoxia (Spo2 <95% even with supplemental oxygen)  Dyspnea  Open pneumothorax or flail chest, Suspected pneumothorax  Significant external hemorrhage or suspected internal hemorrhage  Abnormal neurologic status, GCS score ≤13  Seizure activity  Sensory or motor deficit  Penetrating trauma to the head, neck, or torso. or proximal to the elbow and knee in the extremities  Amputation or near amputation proximal to the fingers or toes Dr. Pritesh Vyas (M.D.)
  • 48. Any trauma in the presence of the following is critical • History of serious medical conditions (e.g., coronary artery disease, chronic obstructive pulmonary disease, bleeding disorder) • Age >55 • Hypothermia • Burns • Pregnancy Dr. Pritesh Vyas (M.D.)
  • 49. Dr. Pritesh Vyas (M.D.)