Primary Survey Check Pupils size; evidence of inequality reaction response to light Sensory- can feel in all parts of body? Motor- can move all limbs?
WHEN TO TRANSFER TO TRAUMA CENTER? TRAUMA SCORING For appropriate Triage Hospital Transfer Assurance of quality Care PEDIATRIC TRAUMA SCALE Size Airway Systolic Blood Pressure > 20 kgs +2 10-20 kgs +1 < 10 kgs 1 NORMAL +2 MAINTAINABLE +1 NOT MAINTAINABLE -1 > 90 mm Hg +2 50-90 mm Hg +1 < than 50 mm Hg -1
SECONDARY SURVEY What are the Important points in the HISTORY of TRAUMA VICTIMS? Systematic Evaluation S- Signs and symptoms A- Allergies M- Medications taken P- Pertinent History L- Last meal taken E- Events preceeding the injury
SECONDARY SURVEY Physical Examinations Look for signs of injury D- Deformities O- Open injuries T- Tenderness S- Swelling
SECONDARY SURVEY Physical Examinations –Head to Toe Examination of the Head A. Scalp and Skull ;Look for signs of injury D- Deformities O- Open injuries T- Tenderness S- Swelling
SECONDARY SURVEY A. Scalp and Skull Brisk bleeding= rapid suture closure Nasopharyngeal bleeding= French 20 foley catheter Ecchymosis about the ear ( battle sign ); or about the eyes ( raccoon eyes )= presumptive evidence of BASAL SKULL FRACTURE
SECONDARY SURVEY B. Pupils Symmetry Reactivity Size C. Ears and Nose Blood or Fluid from opening
SECONDARY SURVEY D. Mouth D- Deformities O- Open Injuries T- Tenderness S- Swelling F- Foreign Bodies
SECONDARY SURVEY A. Examination of the Neck D- Deformities O- Open Injuries T- Tenderness S- Swelling B. Cervical Vertebrae Deformities Palpate for step-up Deformities
SECONDARY SURVEY Examination of the Chest ; Check for Symmetry of Expansion Breath Sounds Abrasions Subcutaneous Emphysema Open Wounds Rib or Clavicular Fracture
SECONDARY SURVEY Examination of the Abdomen A. Inspection Deformities; Abdominal Distension Open Injuries Protruding Organs Swelling & Discoloration
SECONDARY SURVEY B. Palpation Rigidity ( Hardness) Tenderness Masses C. Auscultation Listen for bowel sounds
SECONDARY SURVEY Diagnostic Aids for the Abdomen Diagnostic Peritoneal Lavage for suspected blunt injury One shot IVP if GU injury is suspected A Cystogram may be done by clamping the catheter CT scan if accessible and available can be done on stable patients
SECONDARY SURVEY Examination of the Pelvis and Rectum Check for scrotal hematoma Check for blood in the urethral meatus Check for a high lying prostate Blood on rectal exams may indicate injury to the rectum or neighboring organs Blood in the vagina vault or introitus may indicate pelvic fracture
SECONDARY SURVEY Examination of the Back A. Inspection Chest Wall deformities Open Injuries Foreign Objects Dislocation B. Palpation Palpate for deformities along spine Tenderness
SECONDARY SURVEY Examine Upper & Lower Extremities A. Inspection >> Deformities, Open injuries, Swelling >> Color >> Motion, Wiggle test >> Sensation B. Palpation >> Tenderness >> Crepitation >> Deformities
SECONDARY SURVEY Pupils Normal Findings Abnormal Findings > constricts when >> No reaction to exposed to sun- light light >> R emains constric ted >Dilate with less >> Fixed, dilated or light unequal >Should be of the same size
SECONDARY SURVEY ESSENTIAL LAB. PROCEDURES Baseline Hematocrit, Blood Typing, and Cross Matching. A cross table x-Ray of the cervical spine w/o the victim being hyperextended. “Swimmer’s” view if not possible; x-Ray tube positioned at axilla directed to C-7. It will view lower Cervical vertebra and T1.
SECONDARY SURVEY WHERE and HOW do WE LOOK for Blood Loss? There are three sites for exsanguinating hemorrhage: CHEST ABDOMEN THIGH (2-3 liters of blood in Hematoma)
SECONDARY SURVEY Patients with injury to these sites; Thoracic is 1 st followed by Abdomen then extremities. Control of life threatening activities takes precedence over limb salvage. Chest x-Ray important especially looking for sites of blood loss .
Other concerns in care of Casualties Adequately Immunized Patients A. Last dose w/in 5 years>>> All Wounds >> NONE B. Last dose w/in 10 years: Non Tetanus prone wound>>> NONE Tetanus prone Wound>>>> Toxoid C. Last dose > 10 years >> All Wounds >>> Toxoid Inadequately Immunized Patients Non Tetanus Prone Wound>>>> Toxoid Tetanus prone Wound>>>Toxoid and Antitoxin after one to 12 months>> Toxoid
5. If patient is unconscious maintain immobilization and support ABC. Turn to side if patient vomits to avoid aspiration but maintain head & neck immobilization .
6. Call for an ambulance or medical team. Monitor and record breathing, pulse and level of response every 10 minutes until help arrives.
PATIENTS WITH HISTORY OF HEAD TRAUMA
BLEEDING FLOW CHART 1.LOCATE BLEEDING SITE 2. APPLY DIRECT PRESSURE ON THE WOUND BLEEDING STOPPED ? 3. ELEVATE EXTREMITY ABOVE CASUALTY’s HEART 5. TREAT FOR SHOCK CARE FOR WOUND SEEK MEDICAL ATTENTION BLEEDING STOPPED? 4. LOCATE PRESSURE POINTS & APPLY PRESSURE; KEEP PRESSURE OVER WOUNDS TREAT SHOCK BLEEDING STOPPED? BLEEDING FROM ARM OR LEG 6. APPLY TOURNIQUE AS LAST RESORT 7. SEEK MEDICAL ATTENTION NO YES YES NO YES NO NO YES
HEAD INJURIES 1. CHECK ABC’s & TREAT ACORDINGLY 2. CHECK FOR POSSIBLE SPINAL INJURY IMMOBILIZE HEAD AND NECK HEAD BLEEDING 3. DIRECT PRESSURE OVER THE WOUND. If FRACTURE SUSPECTED APPLY PRESSURE TO OUTER EDGES OF THE INTACT BONE 4. DO NOT REMOVE IMPALED OBJECTS UNCONSCIOUS 5. RAISE VICTIMS HEAD& SHOULDERS IF NO SPINAL INJURY & NOT IN SHOCK 6 KEEP PATIENT LYING ON THE GROUND 7. SEEK IMMEDIATE MEDICAL ATTENTION IF W/ SIGNS OF POSSIBLE BRAIN INJURY YES NO NO YES
ABDOMINAL INJURIES Flow Chart 1.CHECK ABCs and TREAT ACCORDINGLY PENETRATING WOUNDS IMPALED OBJECTS PROTRUDING ORGANS ? 2. DO NOT REMOVE OBJECT Stabilize subject 3. DO NOT RE-INSERT ORGAN DO NOT TOUCH ORGAN COVER W/ MOIST CLEAN DRESSING BLOW TO ABDOMEN ? 4. ROLL VICTIM TO ONE SIDE IN CASE OF VOMITING 5. SEEK MEDICAL ATTENTION YES NO NO YES NO YES
3. Grey-blue color of mouth , lips, nailbeds & skin
4. Crackling feeling of the skin around the site
of wound caused by air around the tissues
CHEST INJURIES Flow Chart CHECK ABC’s and TREAT ACCORDINGLY PENETRATING WOUNDS IMPALED OBJECTS SUCKING CHEST WOUNDS DO NOT REMOVE OBJECT Stabilize subject SEAL WOUND TO PREVEN T AIR TO ENTER RIB FRACTURE 4. STABILIZE RIBS and CHEST 5.SEEK MEDICAL ATTENTION YES NO NO YES YES NO
Common among casualties who have been crushed beneath debris b ecause of explosives, natural disas ters, or vehicular disasters. They are at risk of developing ”Crush Syndrome ” or traumatic rhabdomyolysis resulting from skeletal muscle injury with release of muscle cell content into
Local injuries includes fractures, swelling, blisters, internal bleeding. The crushing force may also impair the circulation, causing numbness at or below the site of injury; no detectable pulse in the crushed limb.