3. ISS calculation
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Region Injury
Description
AIS Square
Top Three
Head & Neck Cerebral Contusion 3 9
Face No Injury 0
Chest Flail Chest 4 16
Abdomen Minor Contusion of Liver
Complex Rupture Spleen
2
5 25
Extremity Fractured femur 3
External No Injury 0
ISS = (The 3 most AIS score )2 and added together 50
www.trauma.org/archive/scores/iss
4. Injury Severity Score; ISS
Region Injury Description AIS Square Top Three
Head & Neck Cerebral Contusion 3 9
Face No Injury 0
Chest Flail Chest 4 16
Abdomen Minor Contusion of Liver
Complex Rupture Spleen
2
5 25
Extremity Fractured femur 3
External No Injury 0
Injury Severity Score: 50
AIS Score Injury
1 Minor
2 Moderate
3 Serious
4 Severe
5 Critical
6 Survivable
ISS
1-8 Minor
9-15 Moderate
16-24 Serious
25-49 Severe
50-74 Critical
75 Maximum
7. Major trauma
CRAMS scale ≤ 8 scores
Assessment 2 1 0
C : circulation Normal capillary
refill
& SBP ≥ 100
Delay capillary refill
or
SBP ≥ 85 < 100
No capillary refill
or SBP < 85
R : respirations Normal Labored or shallow Absent
A : abdomen Abdomen &
thorax no tender
Abdomen & thorax
tender
Abdomen & rigid
or flail chest
M : motor Normal Response only pain No response
S : speech normal confused No intelligible
words
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8. การใช CRAMS score
ประเมิน Severe Trauma
• C = Capillary refill time เปนอยางไร
• R = ลักษณะการหายใจเปนอยางไร
• A = เจ็บ ตึง แนน ทรวงอกและหนาทองรึไม
• M = การขยับแขน ขา เปนอยางไร
• S = พูดจารูเรื่องรึไม
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9. Detection of Severe Trauma
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ISS
score
> 25
Severe
trauma
CRAMS
scores
≤ 8
Major
trauma
10. Severe Trauma
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ISS
score
> 25
Severe
trauma
Severity
• มีบาดแผลฉีกขาดรุนแรง ยาว
ตั้งแต่ 4 นิ้วขึ้นไป บริเวณ
ใบหน้าหรือบาดแผลที่ลึกเข้า
ไปในเนื้อเยื่อหรือกล้ามเนื้อ
กระดูกหักหรือเคลื่อนที่
• บาดเจ็บที่อยู่ในระยะฉุกเฉิน
หรือวิกฤต
• มีความรุนแรง เป็ นตายเท่ากัน
• บาดเจ็บรุนแรงมาก จนไม่
สามารถรักษาให้รอดชีวิตได้
Region
Head & Neck
Face
Chest
Abdomen
Extremity
External
11. Severe Trauma
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CRAMS
scores
≤ 8
Major
trauma
Assess 2 1 0
C :
circulation
Normal
capillary
refill
& SBP ≥
100
Delay
capillary
refill or
SBP ≥ 85 <
100
No
capillary
refill or
SBP < 85
R :
respiration
Normal Labored or
shallow
Absent
A :
abdomen
Abdomen
& thorax
no tender
Abdomen &
thorax
tender
Abdomen
& rigid or
flail chest
M : motor Normal Response
only pain
No
response
S : speech normal confused No
intelligible
words
24. Advance Trauma Life Support
1° survey and resuscitation 2° survey and investigation
Airway: secure a clear airway
and control cervical spine
Breathing: treat hypoventilation,
severe chest injury
Circulation : control
haemorrhage and treat shock
Disability: assess disability
Exposure / Environmental
control: completely undress the
patient but prevent hypothermia
Head to toe examination
History:
• MIVT/ MIST
(mechanism of injury,
injury sustained, V/S,
treatment)
• AMPLE
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25. • Reassessment
Hypovolemic shock
Class I (<15%)
• Tachycardia
•Control bleeding
• Assess : ABC, signs of shock
• HR, V/S, LOC, Capillary refill time, O2 sat
• Evaluate mechanism of injury and other injuries
Primary survey and resuscitation
Class II (15-30%)
• Clinical symptoms
Class III (30-40%)
• Perfusion alteration
Class IV ( >40%)
• Life-threatened conditions
• O2 mask with reservoir bag 10
LPM
• Prepared : definite airway
• Initiate 2 large-bore IV
• G/M, CBC, Hct.
• Prepare adjuncts : N-G tube ,
Foley catheter, ECG, cut down
• Prepare for : diagnostic tests,
surgical treatment
• Prepared : volume
resuscitation, fluid challenge
test
•Monitor : V/S, N/S, O2 sat, LOC ,GCS
•Nursing Record
• O2 mask with
reservoir bag 10 LPM
• CBC, Hct.
• Prepare for : surgical
treatment
• Prepared : volume
replacement
• Prepared : definite airway
• Initiate 2 large-bore IV
• G/M, CBC, Hct., ABG
• Prepare adjuncts : Foley
catheter, N-G tube, ECG, cut
down
• Prepare for : diagnostic tests,
surgical treatment
• Prepared : volume
replacement, fluid challenge
test
26. Algower’s Shock index
0.5-0.6 = normal
0.8 = 10-20 %
1.0 = 20-30 %
1.1 = 30-40 %
1.5-2.0 = 40-50 %
SI = HR / SBP
EX.
HR 110, BP 100/70
SI = 110/100
= 1.1
เสียนํ้า 30-40%
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27. Class of Hemorrhagic shock
Class I
Hemorrhage
• 15% blood
volume loss
• Minimal
tachycardia
• No
measurement
changes
• Do not
required
replacement
• Restore blood
volume within
24 hr
Class II
Hemorrhage
• 15-30% blood
volume loss
• Present
clinical
symptoms
• Pertinent
clinical
findings
• Require fluid
replacement
Class III
Hemorrhage
• 30-40% blood
volume loss
• Present
classic signs
of inadequate
perfusion
• Require fluid
management
or transfusion
• Emergency
operation
Class IV
Hemorrhage
• > 40% blood
volume loss
• Immediately
life-
threatened
• Require fluid
resuscitation
and rapid
transfusion
• Require
immediate
surgical
intervention
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28. CLASS I CLASS II CLASS III CLASS IV
Blood loss (mL) Up to 750 CLASS II CLASS III CLASS IV
Blood loss (% blood volume) Up to 15% 15%–30% 30%–40% >40%
Pulse rate (BPM) <100 100-120 120-140 >140
Systolic b pressure Normal Normal Decreased Decreased
Pulse pressure (mm Hg) Normal or
increased
Decreased Decreased Decreased
Respiratory rate 14–20 20–30 30–40 >35
Urine output (mL/hr) >30 20–30 5–15 Negligible
CNS/mental status Slightly
anxious
Mildly
anxious
Anxious,
confused
Confused,
lethargic
Initial fluid replacement Crystalloid Crystalloid Crystalloid
and blood
Crystalloid
and blood
Estimated Blood Loss
Based on Patient’s Initial Presentation
ATLS, 2012
29. • Airway management
• O2 mask with reservoir bag 10 LMP
• Prepare for : definite airway
• Prepare for : cardiocentesis, thoracentesis,
ICD, surgical treatment
• Prepare for : X-ray, diagnostics tests, Adjuncts
• Maintain oxygenation
• Monitor : V/S, N/S, LOC, O2 sat, Capillary refill
time, EKG.
•Nursing record
Non-hemorrhagic shock
• Assess : HR,
• Assess : V/S, LOC, O2 sat, Capillary refill time
• History of injury : MIVT
Cardiogenic shock
• Distended neck veins
• Dypsnea, tachycardia
• Decrease breath sounds
• Trachea deviation
Spinal Shock
• Paresis, paralysis
• Airway management
• O2 mask with reservoir bag 10 LMP
• Prepare for : definite airway
• Prepare for : X-ray, diagnostics tests
• Maintain normotension
• Monitor : V/S, N/S, LOC, O2 sat, Capillary refill
time
Primary survey and resuscitation
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