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Principles Of Trauma Care (2)

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  • 1. PRINCIPLES OF TRAUMA CARE CELSO M. FIDEL, MD, FPCS, FPSGS Diplomate Philippine Board of Surgery
  • 2. LOVE your CALLING with PASSION . It is the MEANING of your LIFE Rodin
  • 3.  
  • 4. Vehicular Accident
  • 5. Smash up Cars
  • 6. Truck involved in the Mishap
  • 7. On the spot reporting
  • 8.
    •  Initial Assessment used to identify and
    • treat conditions that pose as immediate
    • treat to patient’s life.
    •  Survey the scene; make sure that it’s
    • safe
    •  Check for responsiveness by gently
    • shaking the patient’s shoulders and
    • asking him ” ARE YOU OKEY’?
    Primary Survey
  • 9.
    • 4 Levels of Responsiveness
    • 1. ALERT- awake, follows command, oriented as to time, place and person
    • 2. Verbal- speaks only when spoken to
    • 3. Pain- respond only to painful stimulus
    • 4. Unresponsive - does not respond to any stimulus; eye closed; does not have any verbal output; does not flinch when pain is applied.
    Primary Survey
  • 10.
    •  WHAT DO YOU INITIALLY DO TO AN
    • INJURED PATIENT?
    • A. ENSURE ADEQUATE AIRWAY
    • B. BREATHING
    • C. CIRCULATION AND HEMORRHAGE
    • CONTROL
    • D. DISABILITY( NEUROLOGIC STATUS)
    • E. EXPOSURE OF THE PATIENT/
    • ENVIRONMENTAL FACTORS(COMPLETELY
    • UNDRESS THE PATIENT)
    Primary Survey
  • 11. A, B, C’s of Basic Life Support
  • 12.
    • A. ENSURE ADEQUATE AIRWAY
    •  Responsive patient- if patient can speak the
    • airway is not obstructed .
    • Unresponsive patient- needs aggressive
    • airway maintenance immediately; make
    • sure airway is open and patient is breathing
    • adequately.
    • Trauma patient- establish adequate airway
    • and cervical spine control. Apply cervical
    • collar if needed.
    Primary Survey
  • 13. AIRWAY PATENCY
  • 14.
    • A. ENSURE ADEQUATE AIRWAY
    • Airway Obstruction Management
    •  Advantages of OROTRACHEAL intubation
    •  direct visualization of the vocal cords
    •  ability to use larger diameter
    • endotracheal tubes
    •  applicability to apneic patients
    •  Operative Intervention> CRICOTHYROIDOTOMY
    •  only tubes < 6mm can be inserted
    Primary Survey
  • 15.
    • A. ENSURE ADEQUATE AIRWAY
    • Airway Obstruction Management
    • Snoring and gurgling sound implies partial
    • . PHARYNGEAL OCCLUSION ; Hoarseness implies
    • LARYNGEAL OBSTRUCTION .
    • Nasotracheal intubation- for patients breathing
    • spontaneously.
    • Orotracheal intubation- for cervical spine injuries
    • provided manual in-line cervical immobilization is
    • maintained.
    Primary Survey
  • 16. REMOVAL of FOREIGN BODIES
  • 17.
    •  HOW DO WE MAINTAIN THE AIRWAY AND SAFEGUARD THE CERVICAL SPINE?
    •  Crash Helmet should be left in place until a cross
    • table x-Ray has been done and the cervical spine
    • cleared of any injury.
    •  Orotracheal or nasotracheal airway can be helpful
    •  Needle or Surgical Cricothyroidotomy is an easy,
    • fast and safe access to the airway.
    •  Endo tracheal Intubation; best airway maintenance
    • device.
    Primary Survey
  • 18.
    •  HOW DO WE MAINTAIN THE AIRWAY AND SAFEGUARD THE CERVICAL SPINE?
    •  Keep airway patent w/o compromising spine
    • injury.
    •  The AIRWAY must be cleared of blood, loose
    • teeth and dentures, or foreign bodies.
    •  Do the JAW THRUST maneuver w/o hyperextension
    • of the head.( grasping the angles of the
    • lower jaw and displacing the mandible
    • forward)
    •  Strap forehead of the victim on the stretcher
    • or any board used to immobilize the
    • patient with sandbags on both sides of the
    • head.
    Primary Survey
  • 19. Methods of Opening Airway
  • 20.
    • B. HOW DO WE ASSESS BREATHING?
    •  Assess for adequacy of ventilation and
    • maximum gaseous exchange.
    •  PATENCY of the AIRWAY does NOT mean
    • that VENTILATION is adequate.
    •  Expose and examine the chest for rate &
    • depth.
    •  Inspect and palpate the neck and chest for
    • evidence of external trauma, fractures,
    • tracheal deviation & disparity, subcutaneous
    • emphysema, lack of movement of hemithorax
    •  Percuss for hyperresonance and dullness Responsive patient- if patient can speak
    • the airway is not obstructed
    • Unresponsive patient- needs aggressive
    • airway maintenance immediately; make
    • sure airway is open and patient is
    • breathing adequately
    • Trauma patient- establish adequate air-
    • way and cervical spine control. Apply
    • cervical collar if needed
    Primary Survey
  • 21.
    • B. BREATHING
    •  ADEQUATE BREATHING
    •  full rise and fall of chest
    •  early breathing
    •  normal respiratory rate 12-20/min
    • INADEQUATE BREATHING
    •  insufficient rise and fall of the chest
    •  increased respiratory rate
    •  cyanosis of the skin, lips and nail beds
    •  mental status changes
    •  inadequate respiratory rate
    Primary Survey
  • 22. Feeling for Breathing
  • 23.
    • B. BREATHING
    •  Remember cyanosis is a late sign, and should
    • not be relied upon to determine inadequacy
    • of ventilation
    •  Measurement of end tidal CO2 is the most
    • sensitive indicator of adequacy of ventilation.
    •  Causes of inadequacy of ventilation
    •  Tension pneumothorax
    •  Open pneumothorax
    •  Flail chest/ pulmonary contusion
    Primary Survey
  • 24.
    • B. BREATHING
    •  Management
    •  Commence 100% oxygen; Patients with
    • inadequate ventilation may require assisted
    • ventilation
    •  Suction secretions
    •  Tension/open pneumothorax management
    •  Open pneumothorax should be closed by
    • plastic wrap, sealing only 3 sides
    •  Taping of an examining glove with one
    • finger cut will allow the same.
    Primary Survey
  • 25. Mouth to Mouth Resuscitation
  • 26.
    •  Tension/ Open Pneumothorax mgt. cont’d
    •  If a sealed dressing must be done; CTT
    • must be done at a distant site.
    •  Another maneuver is to seal the open
    • wound w/ vaselinized gauze. If not
    • capable of doing CTT a large bore needle
    • ( 14 or 16) or a vascular cannula should
    • be placed at MCL 2 nd intercostal space.
    • This should be connected IV tubing
    • dipped in a bowl of water.
    •  Patient who is AGITATED in the absence of
    • head injury – HYPOXIA .
    •  In the presence of Head injury R/O hypoxia
    • as the cause of agitation.
    Primary Survey
  • 27.
    • C. HOW DO WE ASSESS CIRCULATION ?
    • Not only controlling hemorrhage but, also
    • restoring adequate perfusion.
    •  Skin perfusion( color, temperature, moisture,
    • capillary return). “BLANCH TEST”
    •  Responsive PATIENT; Pulse rate, quality, and
    • regularity)
    •  Appreciable pulse>> At least 80 mmHg
    • Systolic
    •  Femoral pulse >>> At least 70 mmHg.
    • Systolic
    •  Carotid Pulse >>> “ “ 60 “ “
    • .
    Primary Survey
  • 28.
    • C. HOW DO WE ASSESS CIRCULATION ?
    •  Irregular suggest ; cardiac abnormality
    • threading means HYPOXIA ; cardiac rate
    • and rhythm; Check BP if possible.
    •  Mental Status .Check consciousness level. In
    • the absence of head injury a fall in level
    • signifies>>> Diminished cerebral perfusion
    •  Unresponsive patient- check carotid pulse ;
    • Present if systolic pressure is 60 mm Hg.
    • Determine rate of external hemorrhage.
    Primary Survey
  • 29. CIRCULATION
  • 30.
    •  WHAT ARE THE PRIORITIES OF HYPOVOLEMIC SHOCK?
    •  Gain access to the circulation
    •  Rapidly transfuse fluids or volume expanders
    •  Obtain blood samples and send for
    • BASELINE studies such as hematocrit,
    • typing and cross matching.
    •  Replace Blood loss
    •  Stop the Bleeding
    Primary Survey
  • 31.
    • C. CIRCULATION & CONTROL OF
    • HEMORRHAGE
    • Management:
    •  Control external hemorrhage by direct
    • pressure; No tourniquets/hemostats.
    •  Insert 2 large intravenous catheters
    •  Draw blood for CBC, blood typing, cross
    • matching, chemistries; arterial blood for
    • blood gases.
    •  Rapid crystalloid infusion with warmed
    • Ringer’s Lactate solution.
    Primary Survey
  • 32.
    • C. CIRCULATION & CONTROL OF
    • HEMORRHAGE
    • Management:
    •  Apply pneumatic splint
    •  Begin cardiac monitoring
    •  Insert an indwelling catheter and
    • nasogastric tube unless contraindicated
    •  Prevent hypothermia
    Primary Survey
  • 33. CARDIOPULMONARY RESUSCITATION
  • 34. Primary Survey
    • D. DISABILITY (DO BRIEF NEURO-
    • LOGIC EXAMINATIONS)
    • Determine level of consciousness
    • A – Alert
    • V – Vocal stimuli response
    • Can he speak?
    • Does he make sense?
    • P – Pain stimuli response
    • U- Unresponsive
  • 35. 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?
  • 36. 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
  • 37.
    •  >> TRAUMA SCORING
    •  PEDIATRIC Trauma Scale>> In the absence of proper size BP cuff, Assess BP by assigning these
    • values:
    •  Pulse palpable at Wrist>>>>>+2
    •  Pulse palpable at Groin>>>>> +1
    •  Pulse not Palpable>>>>>>>>>>> -1
    WHEN TO TRANSFER TO TRAUMA CENTER?
  • 38.
    •  >> TRAUMA SCORING
    •  Central Nervous System Status
    •  Awake>>>>> +2
    •  Partially Conscious or unconscious> +1
    •  Comatous or Decerebrate >>>>>>>>> -1
    •  Open Wounds
    •  None >>+2 Minor>>> +1 Major -1
    •  Others
    •  Skeletal Injury +2 Closed Fracture +1 Open/Multiple Fracture -1
    • SCORE 6-14 IF < 9 CRITERION FOR DIRECT TRANSPORT Trauma Ctr.
    WHEN TO TRANSFER TO TRAUMA CENTER?
  • 39.
    •  >>TRAUMA SCORING
    WHEN TO TRANSFER TO TRAUMA CENTER? ADULT TRAUMA SCORE 1.SYSTOLIC BLOOD PRESSURE 3. Glasgow Coma Scale 4.EYE OPENING > 89 4 13-16 4 Spontaneous 4 76-89 3 9-12 3 Opens on Command or 50-75 2 6-8 2 verbal stimuli 3 1-49 1 4-5 1 Response to pain 2 0 0 Nil 1 2. RESPIRATORY RATE 5. MOTOR RESPONSE 6. VERBAL 10-29 4 Obeys Command 6 Conscious, Coherent 5 > 29 3 Localizes Pain 5 Disoriented/Incoherent 4 6-9 2 Withdraws to Pain 4 Inappropriate Words 3 1-5 1 Abnormal Flexion 3 Incomprehensible Sounds 2 0 0 Abnormal Extension 2 Nil 1 IF THE PATIENT HAS A SCORE < 11 CRITERION for direct transport into a TERTIARY HOSPITAL OR A TRAUMA CENTER.
  • 40.
    •  WHAT ARE NECESSARY DURING TRANSFER?
    •  Cervical Spine must be protected
    •  Airway is maintained and breathing supported
    •  Infusion must be started to support circulation
    • if necessary.
    •  Control of external bleeding & immobilization
    • of the spine and fractures must be attained.
    •  Locally, the best vehicle for transport in the
    • lieu of an ambulance is the jeepney.
    •  The best backboard support is the backseat of
    • the of the jeepney too.
    WHEN TO TRANSFER TO TRAUMA CENTER?
  • 41.  
  • 42. 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
  • 43. SECONDARY SURVEY Physical Examinations Look for signs of injury  D- Deformities  O- Open injuries  T- Tenderness  S- Swelling
  • 44. 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
  • 45. 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
  • 46. SECONDARY SURVEY B. Pupils  Symmetry  Reactivity  Size C. Ears and Nose  Blood or Fluid from opening
  • 47. SECONDARY SURVEY D. Mouth D- Deformities O- Open Injuries T- Tenderness S- Swelling F- Foreign Bodies
  • 48. 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
  • 49. SECONDARY SURVEY  Examination of the Chest ; Check for  Symmetry of Expansion  Breath Sounds  Abrasions  Subcutaneous Emphysema  Open Wounds  Rib or Clavicular Fracture
  • 50. SECONDARY SURVEY  Examination of the Abdomen A. Inspection Deformities; Abdominal Distension Open Injuries Protruding Organs Swelling & Discoloration
  • 51. SECONDARY SURVEY B. Palpation  Rigidity ( Hardness)  Tenderness  Masses C. Auscultation  Listen for bowel sounds
  • 52. 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
  • 53.  
  • 54. 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
  • 55. SECONDARY SURVEY  Examination of the Back A. Inspection  Chest Wall deformities  Open Injuries  Foreign Objects  Dislocation B. Palpation  Palpate for deformities along spine  Tenderness
  • 56. SECONDARY SURVEY  Examine Upper & Lower Extremities A. Inspection >> Deformities, Open injuries, Swelling >> Color >> Motion, Wiggle test >> Sensation B. Palpation >> Tenderness >> Crepitation >> Deformities
  • 57. SECONDARY SURVEY  Measuring Vital Signs 1. Respiration 2. Pulse Rate 3. Blood Pressure Increased BP Decreased BP 1. Cold environment 1. Heart failure 2. Stress; Pain 2. Trauma 3. Smoking 3. Shock 4. Caffeine 5. Decongestant
  • 58. 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
  • 59. 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.
  • 60. 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)
  • 61. 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 .
  • 62.  
  • 63. Other concerns in care of Casualties
    • Is INFECTION A RISK IN TRAUMA?
    •  It is the leading cause of death occurring
    • beyond 2 days following trauma.
    •  Prevent Infection by :
    •  Repair or Restore mechanical structures
    • and barriers to bacterial contamination.
    •  Support of Host defense > restoring
    • circulating blood volume, adequate tissue
    • oxygenation & nutritional support.
    •  Appropriate use of ANTIBIOTICS .
  • 64. Other concerns in care of Casualties
    • WHAT are the ANTIBIOTICS used IN TRAUMA?
    •  Penicillin derivatives ( Cloxacillin ; Ampicillin)
    • for superficial wounds.
    •  1 st generation Cephalosporins & Clindamycin
    • for more severe injuries.
    •  For Multiple injuries:
    •  Broad spectrum Antibiotics for both gram –
    • & gram positive aerobes such as:
    •  2 nd generation Cephalosporins
    •  Aminoglycosides
    •  4fluoroquinolones w/ Metronidazole
  • 65. Other concerns in care of Casualties
    • WHAT are the ANTIBIOTICS used IN TRAUMA?
    • .  For intra Abdominal Trauma
    •  Ampicillin and Beta lactamase Inhibitors
    •  Broad Spectrum penicillins & Beta lactamase
    • Inhibitors.
    •  Carbapenims
    •  Cefoxitin
  • 66. Other concerns in care of Casualties
    • HOW DO WE GIVE TETANUS PROPHYLAXIS?
    •  Tetanus prone wound :
    •  Wound > 6hours old
    •  > 1 cm. deep caused by missile or Crushing
    • injury.
    •  Burn or Frostbite with:
    •  Signs of infection
    •  Divitalized Tissue
    •  Contaminants
  • 67. 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
  • 68.
    • All injuries to the head are potentially dangerous
    •  Proper assessment of consciousness
      • >> If impaired
        • Damage to the brain
        • Damage to the vessel inside the skull
        • Skull fracture
    HEAD INJURIES
  • 69.
    • I.CONCUSSION
    •  Widespread but temporary disturbance of the
    • brain due to a violent blow to the head.
    • A. REGOGNITION
    • 1. Dizziness or nausea on recovery
    • 2. Loss of memory of events at the time
    • of or immediately preceeding the injury
    • 3. Mild generalized headache
    HEAD INJURIES
  • 70.
    • II. SKULL FRACTURE
    • 1. Suspected in patients of trauma with a
    • head wound
    • 2. There maybe brain damage & bacteria
    • may pass thru easily
    • 3. Patient is unconscious after head injury
    HEAD INJURIES
  • 71.
    • Vomiting
    • Blurred vision
    • Headache
    • Neck and back pain
    • Dizziness
    • Confusion
    • Any obvious depression or break in the skull
    • Any obvious sign or bleeding including periorbital swelling and/or hematoma
    • Fluid dripping from the ears or nose
    INDICATORS OF POSTERIOR BRAIN INJURY
  • 72.
    • III. CEREBRAL COMPRESSION
    •  Very serious condition requiring surgery
    •  Occurs when a pressure is exerted on the brain
    • within the skull due to:
    •  accumulation of blood
    •  swelling of the injured brain
    •  Associated with head injury and skull fracture
    •  Maybe associated with stroke, infection and brain
    • tumor
    HEAD INJURIES
  • 73.
    • RECOGNITION
    • 1. Recent head injury followed by full
    • recovery.
    • 2. Deterioration of level of response, patient
    • becomes disoriented.
    • 3. Intense headache
    • 4. Slow, yet full and strong pulses
    • 5. Unequal or dilated pupils
    HEAD INJURIES
  • 74.
    • 6. Weakness or paralysis on one side of the
    • face or body
    • 7. High temperature or flushed face
    • 8. Drowsiness
    • 9. Obvious change in personality or behavior
    • such as irritability.
    HEAD INJURIES
  • 75.
    • 1. Do a basic assessment of the patient
    • Is the patient awake
    • a. If patient is unconscious, make sure that
    • the patient has a patent airway and is
    • breathing adequately
    • b. Is the breathing normal
    • c. Is there a pulse
    • 2.Check for spinal cord injury
    • a. If there is suspicion of possible brain
    • injury, assume cervical spine fracture
    • unless proven otherwise.
    PATIENTS WITH HISTORY OF HEAD TRAUMA
  • 76.
    • b. Immobilize patient’s head by applying
    • cervical collar or placing sandbags and
    • strapping him to the backboard
    • 3. Control any bleeding in the scalp . Look for other injuries and treat them:
    • a. If there is discharge from an ear, position
    • the patient so that the affected ear is
    • lower. Cover the ear with sterile dressing
    • or clean pad, lightly secured with a
    • bandage. DO NOT PLUG THE EAR .
    PATIENTS WITH HISTORY OF HEAD TRAUMA
  • 77.
    • In case of open skull fracture
    •  Clean the wound with water.
    •  Cover exposed area with clean material.
    •  Do not attempt to reposition bone fragment.
    • DO NOT remove impaled objects. Make a
    • fluffy dressing around the impaled
    • object to stabilize it.
    • 4. If patient is conscious , make him comfortable
    • by raising head and shoulders .
    PATIENTS WITH HISTORY OF HEAD TRAUMA
  • 78.
    • 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
  • 79. 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
  • 80. 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
  • 81. 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
  • 82.  
  • 83. Treatment of Abdominal Injuries
    •  L ay the casualty down on his back with his
    • knees in upright position
    •  Check the airway, breathing and circulation,
    • resuscitate if necessary
    •  Impaled objects should not be removed
    • and should be stabilized by bunching
    • dressing around it then fixed with
    • adhesive tape
    •  Protruding intestine should be covered
    • to prevent drying. If casualty coughs
    • prevent further protrusion by pressing
    • on the moist dressing
  • 84. Treatment of Abdominal Injuries
    •  Do not touch with bare hands any exposed
    • organ nor push them back into the abdomen
    •  If casualty suffered from a blunt abdominal
    • injury, turn him to one side, preferably on
    • his injured side or in sitting position which
    • ever makes breathing easier
    •  Do not give the victim anything to eat or drink
    • however you can moisten lips
    •  Call for an ambulance or medical team. Treat
    • patient with shock. Stay with the casualty
    • and check his or her condition every few
    • minutes until help comes
  • 85. Penetrating Chest Wound “Sucking Chest Wound ”
    •  A penetrating chest wound can cause internal
    • damage w/in the chest and upper abdomen.
    • Air can enter the thoracic cavity which has
    • a negative pressure. Lung on the side of
    • wound injury will collapse. If pressure builds
    • up to some extent it may prevent the heart
    • from refilling properly w/ blood, impairing
    • circulation and causing shock. ( Tension
    • pneumothorax )
  • 86. Penetrating Chest Wound “Sucking Chest Wound ”
    •  RECOGNITION
    • 1. Difficult and painful breathing
    • 2. Breathing maybe rapid, shallow & uneven
    • 3. Casualty has a feeling of impending doom
    • There may also be:
    • 1. Signs of shock
    • 2. Coughing up frothy, red blood
    • 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
  • 87. 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
  • 88. Treatment of Chest Injuries
    •  Check the ABCs and be ready to resuscitate
    • if necessary. Provide firm support for a
    • conscious casualty, in the position he finds
    • most comfortable.
    •  Impaled objects should be stabilized
    •  Place a plastic film on a sucking chest wound
    • and secure the three sides w/ adhesive tape
    • which ensures a one way valve
    •  Stabilize a fractured rib by applying sling and
    • swathe
  • 89. Treatment of Chest Injuries
    •  Call for an ambulance or medical team. Treat
    • the patient for shock. Stay with him and
    • check his condition every few minutes until
    • help comes.
    •  If the patient becomes unconscious, open the
    • airway and check breathing. Be ready to
    • resuscitate if needed; Place him lying with
    • injured side uppermost.
    •  Do not probe, clean, or remove foreign body,
    • stuck clothing to chest wound.
  • 90. AVULSIONS
    •  Wash and clean wound
    •  Control bleeding by direct pressure
    •  Compression dressing
    •  Call an ambulance or medical team.
    • or bring the patient to a hospital
  • 91. AMPUTATIONS
    •  Amputation is forceful partial or complete
    • removal of a limb. It is sometimes
    • possible to “replant” the amputated
    • part so, its important to locate and
    • preserve it. The sooner the casualty
    • and the severed part reaches the
    • hospital, the better.
  • 92. AMPUTATIONS
    •  CARE OF THE CASUALTY
    •  Control blood loss by direct pressure &
    • raising the injured part. Do not use a
    • tourniquet
    •  Apply a sterile dressing or non fluffy
    • clean pad secured with a bandage
    •  Treat the casualty for shock
    •  Call for an ambulance or medical team
  • 93. AMPUTATIONS
    •  CARE OF THE AMPUTATED PART
    •  Wrap the severed part in a plastic bag
    •  Wrap again in gauze or soft fabric,
    • place in another container filled with
    • crushed ice
    •  Clearly mark the package w/ casualty’s
    • name time of injury and give it
    • personally to the medical personnel.
  • 94. Impalement
    • This is a condition wherein a foreign
    • object is protruding from a casualty’s
    • body
    • 1. Do not remove the impaled object
    • unless it is impaled in the cheek or
    • affecting the airway or CPR
    • 2. Check the airway & breathing. Be
    • ready to resuscitate if necessary
  • 95. Impalement
    • 3. Check the airway & breathing. Be
    • ready to resuscitate if necessary
    • 4. Control the bleeding
    • 5. Prevent further injury by stabilizing
    • the object with bulky dressing, then
    • applying bandage
    • 6. Call an ambulance or a medical team
  • 96. Gunshot Wounds
    • Military gunshot wounds are often heavily
    • contaminated with delays in treatment.
    • The severity of the wound does not
    • depend on the velocity of the bullet but
    • depends on the amount of kinetic
    • energ transferred to the tissues. .
  • 97. Gunshot Wounds
    • . How to Manage:
    • 1. C heck for ABC’s . Resuscitate if necessary
    • 2. Control bleeding by direct pressure
    • on the wound
    • 3. Stabilize injured part if extremity is
    • affected. Insert an intravenous access
    • 4. C over wound w/ clean , sterile dressing.
    • 5.Transport immediately for wound
    • debridement, Tetanus prophylaxis &
    • antibiotic coverage.
  • 98. Crushing Injuries
    •  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
    • the general circulation.
  • 99. Crushing Injuries
    • 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.
    •  Dangers of Prolonged Crushing
    •  Shock- If pressure is removed, tissue fluids
    • may leak into the damage muscle tissue.
    •  Crush Syndrome- Toxic substances from
    • damage tissues are suddenly released. This
    • is extremely serious and fatal.
  • 100. Crushing Injuries
    • TREATMENT for CRUSHING VICTIMS
    •  C asualties Crushed for less than 10 minutes
    •  Re lease the casualty as quickly as possib le
    •  C ontrol external bleeding & cover wound
    •  Secure & support suspected fracture
    •  Examine & observe for shock; Treat
    • accordingly
    •  Call for an ambulance. Insert an IV
    • line
  • 101. Crushing Injuries
    • TREATMENT for CRUSHING VICTIMS
    •  Casualties Crushed for more than 10 minutes
    •  Call for an ambulance or medical team
    •  Insert an IV line while waiting for an
    • ambulance
    •  Comfort and reassure casualty until
    • help comes
  • 102. Blast Injury
    • Injuries Sustained in Blast Explosions
    • 1. Rupture of the Tympanic Membrane=
    • Ear pain;ringing in the ears; hearing
    • loss
    • 2. Respiratory Effects= Inhalation injury;
    • airway hemorrhage
    • 3. Skull Fractures
    • 4. Burns
    • 5.Fractures
  • 103. Blast Injury
    • Injuries Sustained in Blast Explosions
    • 6. Traumatic Brain Injury
    • 7. Arterial Air Emboli= Confusion;
    • disorientation; focal neurologic signs
  • 104. Blast Injury
    • TREATMENT of VICTIMS in Blast Explosions
    • 1. Lay the casualty on the ground. Reassure
    • patient.
    • 2. Maintain an open airway. Check breathing.
    • Be ready to resuscitate if necessary.
    • 3. Control bleeding; Cover wounds with clean
    • and if possible sterile dressing. May apply
    • a cervical collar if neck injury is suspected.
    • 4. Call an ambulance or medical team; May
    • start an intravenous line if trained to do so.
    • 5. Continuously monitor patient until help arrives
  • 105. Eye Wounds
    •  The Eye can be bruised or cut by direct blows
    • or by sharp, chipped fragments of metal &
    • glass. All eye injuries are potentially
    • serious. Corneal injury can lead to scarring
    • with resultant loss of vision. There may be
    • rupture of the eyeball.
    •  RECOGNITION
    •  Visible Wound
    •  Bloodshot appearance to the injured eye
    •  Partial or total loss of vision
    •  Leakage of blood or fluid from the wound
  • 106. Eye Wounds
    • TREATMENT
    • 1. Lay the casualty down on his back, holding
    • his head to keep it as still as possible.
    • 2.Tell the casualty, keep both eyes still;
    • movement of the good eye will cause
    • movement of the injured eye; Do not
    • touch, attempt to remove an embedded
    • foreign body.
    • 3. Ask the casualty to hold an eye pad over
    • injured eye. Bandage the pad in place.
    • 4. Take or send the casualty to a hospital.
  • 107. Internal Bleeding
    •  TREATMENT
    • 1. Help the casualty to lie down; raise and
    • support his legs. Loosen clothing at the
    • neck, chest and waist. If unconscious
    • place him with injury uppermost.
    • 2. Call for an ambulance or a medical team.
    • 3. Insulate him from the cold. Monitor and
    • record breathing, pulse and level of
    • response every 10 minutes.
    • 4. Note the type, amount and source of blood
    • loss coming from bony orifices.
  • 108. Bleeding At Special Sites
    • Scalp and Head Wounds
    • 1. It has a rich blood supply, when damaged,
    • the skin splits >>gaping wound>> profuse
    • bleeding.
    • 2. May be part of a more serious underlying
    • injury>> skull fracture
    • TREATMENT
    • 1. With gloves replace displaced skin flaps
    • 2. Direct pressure over sterile dressing on wound
    • 3. Secure dressing w/ roller bandage
    • 4. If unconscious, open airway; Check BC’s
    • 5. Send casualty to Hospital
  • 109. Bleeding At Special Sites
    • Wounds To The Palm
    •  Richly supplied with blood, wound bleed
    • profusely; Deep wound may severe
    • tendons and nerves.
    • TREATMENT
    • 1. Press a clean pad or sterile dressing firmly
    • into the palm and let him clench his fist
    • over it. If he finds it difficult to press hard,
    • let him use the uninjured hand to grasp it.
    • 2. Bandage the casualty’s fingers so they are
    • clenched over the pad . Tie knot over fingers.
    • 3. S upport arm w/ elevation sling; Send to hospital
  • 110. Bleeding At Special Sites
    •  Wounds To The Joint Creases
    •  Major vessels cross the inside of the elbow and
    • knee; if severed will bleed profusely.
    •  TREATMENT
    •  Press a clean pad over the injury. Bend the
    • joint as firmly as possible.
    •  With the joint firmly bent to press on the pad,
    • raise the limb. If possible, lay casualty
    • down to reduce shock.
    •  Take or send the casualty to hospital; Release
    • the pressure briefly every 10 minutes to
    • restore normal blood flow
  • 111. Bleeding At Special Sites
    • Bleeding From The Ear
    •  Bleeding that originates from inside the ear
    • generally follows a ruptured eardrum which
    • may be caused by explosion. Sharp pain is
    • experienced followed by earache & deafness.
    •  From a head injury blood may appear thin &
    • w atery w/c is serious >> CSF leaking from brain.
    • TREATMENT
    • 1. Help victim into half sitting position, head
    • inclined to the injured side
    • 2. Cover the ear with a sterile dressing or clean pad
    • 3. Send or take the casualty to the hospital
  • 112. Bleeding At Special Sites
    • Bleeding From The Mouth
    •  It usually originates from cuts from the
    • tongue, lips, or lining of the mouth usually
    • from victims teeth. Bleeding can be profuse
    • and alarming.
    • TREATMENT
    • 1. Sit the casualty down, with their head forward &
    • inclined towards the injured side to allow
    • blood to drain.
    • 2. Ask victim to press the wound between
    • thumb & finger w/ a gauze pad over the wound .
  • 113. Bleeding At Special Sites
    • 3. If bleeding persists, replace the pad with a
    • fresh one. Tell victim to let escaping blood
    • dribble; If swallowed it may induce vomiting.
    • 4. Do not wash the mouth as this may disturb
    • a clot.
    • 5. Advise casualty to avoid hot drinks for 12
    • hours.
    • 6. If the wound is large or bleeding persists
    • beyond 30 minutes, or recurs; seek
    • medical or dental consultation.
  • 114. Bleeding At Special Sites
    • Nosebleeds
    •  Most commonly occurs when blood vessels
    • inside the nostrils rupture. It is usually
    • un pleasant , but can be dangerous if casualty
    • lo ses a lot of blood. Thin & watery noseble eds
    • a fter head injury is serious proble m= CSF leakag e.
    • TREATMENT
    • 1. Sit the casualty down with his head held
    • forward. Do Not let his head tip back; blood
    • may run down his throat and induce vomiting .
  • 115. Bleeding At Special Sites
    • 2. Ask the casualty to breathe thru his mouth,
    • (calm effect) and to pinch nose just below
    • the bridge. Help him if necessary.
    • 3. Tell him not to speak, swallow, cough, spit,
    • sniff, as it disturbs a blood clot. Give him a
    • clean cloth or tissue to mop up dribble.
    • 4. After 10 minutes, tell the casualty to release
    • the pressure. If his nose is still bleeding,
    • reapply the pressure for further periods of
    • 10 minutes.
  • 116. Bleeding At Special Sites
    • 4. If it persists beyond 30 minutes, take or send
    • the casualty to hospital.
    • 5. Once the bleeding is under control, and with
    • the casualty still leaning forward, clean
    • gently around his nose and mouth with
    • lukewarm water.
    • 6. Advise the casualty to rest quietly for a few
    • hours and to avoid exertion and, in
    • particular, not to blow his nose, as this will
    • disturb any clot.
  • 117. Thank You