Trauma By Lauren Young FY1 Trauma & Orthopaedics

Trauma Leading cause of death in UK in 1-40 year olds Trimodal deaths: 50% immediate (secs to mins), CNS or large vessel injuries 30% early (mins to hours), uncontrolled blood loss or secondary CNS injury, ‘golden hour’ 20% late (days to weeks), sepsis or multi-organ failure

Leading cause of death in UK in 1-40 year olds

Trimodal deaths:

50% immediate (secs to mins), CNS or large vessel injuries

30% early (mins to hours), uncontrolled blood loss or secondary CNS injury, ‘golden hour’

20% late (days to weeks), sepsis or multi-organ failure

‘ Trauma call A&E resus’ Can be daunting GO! Put on aprons, gloves and goggles You are useful Talk to paramedics YOU WILL NEVER BE ALONE!

Can be daunting

GO! Put on aprons, gloves and goggles

You are useful

Talk to paramedics

YOU WILL NEVER BE ALONE!

A.T.L.S Advanced Trauma Life Support Developed in 1976 by Dr Jim Styner Multi-disciplinary and evidence-based Common language, common approach

Advanced Trauma Life Support

Developed in 1976 by Dr Jim Styner

Multi-disciplinary and evidence-based

Common language, common approach

Brief history A – allergies M – medications (given & regular) P – past medical history L – last meal E – events inc. change in condition (fall >3ft, high velocity, bullseyed windscreen, LOC, children, elderly)

A – allergies

M – medications (given & regular)

P – past medical history

L – last meal

E – events inc. change in condition

(fall >3ft, high velocity, bullseyed windscreen, LOC, children, elderly)

PRIMARY SURVEY - Airway Look for: Foreign bodies Blood Facial trauma Battle’s sign ‘ Racoon’ eyes Singed nose hairs

Look for:

Foreign bodies

Blood

Facial trauma

Battle’s sign

‘ Racoon’ eyes

Singed nose hairs

Airway Listen: Talking / stridor ? Airway adjuncts: Oropharygeal Nasopharyngeal Endotracheal tube Extra Glottic Devices Surgical airway

Listen:

Talking / stridor ?

Airway adjuncts:

Oropharygeal

Nasopharyngeal

Endotracheal tube

Extra Glottic Devices

Surgical airway

C - spine Secure with 3 point technique: Correctly sized rigid collar Head blocks Tape to bed

Secure with 3 point technique:

Correctly sized rigid collar

Head blocks

Tape to bed

C - spine ‘ Clear this patient’s C-spine please’ Ask about pain Examine for tenderness Neurological exam Adequate lateral c-spine plain radiograph Cannot exclude if distracting injury, intoxication, altered mental state, dangerous mechanism of injury

‘ Clear this patient’s C-spine please’

Ask about pain

Examine for tenderness

Neurological exam

Adequate lateral c-spine plain radiograph

Cannot exclude if distracting injury, intoxication, altered mental state, dangerous mechanism of injury

Breathing Look – accessory muscle use, oxygen should be present Feel – trachea position, expansion, percussion Listen – bilateral air entry, added sounds Measure – respiratory rate, sats

Look – accessory muscle use, oxygen should be present

Feel – trachea position, expansion, percussion

Listen – bilateral air entry, added sounds

Measure – respiratory rate, sats

Life-threatening chest conditions A – airway obstruction T – tension pneumothorax O – open pneumothorax M – massive haemothorax F – flail chest C – cardiac tamponade

A – airway obstruction

T – tension pneumothorax

O – open pneumothorax

M – massive haemothorax

F – flail chest

C – cardiac tamponade

Circulation Look – colour, blood loss, including floor Feel – warmth, clammy, pulse, cap refill Listen – heart sounds Measure – pulse, BP, urine output, BM Catheterise, cannulate and take bloods, ABG

Look – colour, blood loss, including floor

Feel – warmth, clammy, pulse, cap refill

Listen – heart sounds

Measure – pulse, BP, urine output, BM

Catheterise, cannulate and take bloods, ABG

Bloods in trauma cases FBC, U&Es, LFT, crossmatch and group & save, DEFG….. DON’T EVER FORGET GLUCOSE Cross match – 1 hour Type specific – 10 mins Universal donor – immediate, O neg, ‘flying squad’ Always give Rhesus negative to women of childbearing age

FBC, U&Es, LFT, crossmatch and group & save, DEFG…..

DON’T EVER FORGET GLUCOSE

Cross match – 1 hour

Type specific – 10 mins

Universal donor – immediate, O neg, ‘flying squad’

Always give Rhesus negative to women of childbearing age

Access problems Femoral access Intraosseous, especially in children Sternal access Drugs can sometimes be given via endotracheal tube

Femoral access

Intraosseous, especially in children

Sternal access

Drugs can sometimes be given via endotracheal tube

Disability A – alert V – voice P – pain U – unresponsive

A – alert

V – voice

P – pain

U – unresponsive

Glasgow Coma Scale

SECONDARY SURVEY Completely expose Log roll Trauma series of radiographs C-spine, chest, pelvis Damage limitation surgery Inform family Thank your team

Completely expose

Log roll

Trauma series of radiographs

C-spine, chest, pelvis

Damage limitation surgery

Inform family

Thank your team

Further resources www.pre-hospitalcare.co.uk www.trauma.org RUMS Surgical Society Wilderness Medicine Society, UCL Volunteer as ATLS helper, patient, observer Arrange paramedic observer shifts

www.pre-hospitalcare.co.uk

www.trauma.org

RUMS Surgical Society

Wilderness Medicine Society, UCL

Volunteer as ATLS helper, patient, observer

Arrange paramedic observer shifts