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Polytrauma
- 1. BY:- HASANAIN G. KHUDHAIR( hasanain.ghaleb@gmail.com) MAYS SALIM MAHDI ZAHRAA SALMAN YAAS KERBALA UNIVERSITY / COLLEGE OF MEDICINE DEPARTMENT OF SURGERY 10-9-2017 polytrauma
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- 3. Objective: 1-defenition 2-epidemiology 3-etiology 4-pathophysiology 5-type of shockin polytrauma 6-Mangment
- 4. definition Polytrauma isa significant injury in at least two of the following six body regions: Head , neck and cervical spine Face Chest and thoracic spine Abdomen and lumbar spine Limbs and bony pelvis External (skin) Significant injury in AIS>=3
- 5. Abbreviated injury scoreAIS >=3 injury severity score ISS >=16
- 6. The defenition ofpolytrauma expanded to include concurrent injury to two or more body parts or systems that result in cognitive ,physical ,psychological or other psychosocial impairment. Ex : TBI in combination with other disabiling condition like amputation,auditory or visual impairment, PTSD and other mental condition
- 7. Criteria of polytraumainclude any one of the following combination injury •Two major system injury + one major limb injury •One major system injury +two major limb injury •One major system injury + one open grade 3 skeletal injury •Unstable pelvis # with associated visceral injury
- 8. Etiology of polytrauma RTA Fallfrom height (blunt or penetrating injury) Assault-اعتداء Airplane crashes ,train derailment Blast Thermal ,chemical injury
- 9. Polytrauma is thethird most common cause of death in all age group. 1-first peak-major neurological or vascular injury 2-second peak-intracranial hematoma , major thoracic or abdominal injury 3-third peak-sepsis and multiple organ fail
- 10. pathophysiology of polytrauma: iscomplex phenomenon aiming at the restoration of homeostasis and preservation of life
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- 12. Type of shockin polytraumatized patient 1.Hemorrhagic shock duo to loss blood voulme ,diagnosis based on vital sign and examination characterized by hypotention tachycardia and cold skin 2.neurogenic shock duo to spinal cord injury that causes distribution of sympathetic outflow to heart and blood vessles characterized by hpotention .bradycardia .warm skin 3.hypoxic shock 4.septic shock
- 13. Phases of traumacare 1.prehospital care 2.emergency department 3.Rehabilitation Prehospital care: TRIAGE Sorting and allocation of treatment to patient according the urgency of their need for care Should be performed rapidly
- 14. How to starttriage
- 15. ATLS Primary survey Identify whatis killing the patient. Resuscitation Treat what is killing the patient. Secondary survey Proceed to identify other injuries. Definitive care Develop a definitive management plan.
- 16. ATLS- PRIMARY SURVEY A– Airway maintenance & control of C.Spine. B –Breathing & ventilation. C– Circulation & haemorrhage control D – Disability limitation E –Exposure & environment. F – Fracture stabilization, folly catheter.
- 17. ATLS- PRIMARY SURVEY A– Airway maintenance & Control of C.Spine If conscious- Ask the pt’s name If unconscious-Look for added sounds (stridor,cyanosis etc) If the pt does not respond to any questions- resuscitate. Always assume a cervical spine injury is present
- 18. ATLS- PRIMARY SURVEY A-AIRWAY Sequenceof events: chin lift Jaw thrust finger sweep suction Oropharyngeal/ orotrachial tube Cricothyroidotomy Trachiostomy
- 19. Primary Survey B- Breathing& ventilation • Exposure • Inspection • Auscultation • Palpation • Pulse oximetry The aim is to hunt out & treat the life threatening thoracic condns which include:
- 20. Primary Survey B- Breathing& ventilation life threatening thoracic conditions: 1. Tension Pneumothorax 2. Open pneumothorax 3. Flail segment 4. Cardiac tamponade
- 21. Primary Survey B- Breathing& ventilation Tension pneumothorax C/F Respiratory distress Tracheal deviation Diminished breath sounds Distended neck veins Immediate needle thoracocentesis thro’ 2ndintercostal space in mid clavicular line reqd.
- 22. Primary Survey B- Breathing& ventilation Open pneumothorax: Sealing of the wound Tube thoracostomy Flail segment: Endotrachial intubation Mechanical ventilation
- 23. Primary Survey B- Breathing& ventilation Cardiac tamponade (almost always seen with a penetrating wound) Beck’s triad: Treatment: needle pericardiocentes Thoracotomy
- 24. ATLS- Primary Survey C-Circulation and hemorrhage control Assessment of blood loss External or obvious Internal or covert chest abdomen pelvis limbs Resuscitation Arrest bleeding Obtain vascular access
- 25. ATLS- Primary Survey C-Circulation and hemorrhage control Adults- 2 lit of Ringer lact soln as initial fluid challenge Children- 20mg/kg of body wt Response to initial fluid challenge: • Immediate & sustained return of vital signs. • Transient response with later deterioration • No improvement.
- 26. ATLS- Primary Survey C-Circulation and hemorrhage control Immediate responders-<20% blood loss Bleeding ceases spontaneously Transient responders- bleeding within body cavities Surgical intervention reqd. Non responders- <40%of blood vol lost require immediate surgery Continued IV fluids detrimental
- 27. ATLS- Primary Survey C-Circulation and hemorrhage control Estimation of blood loss
- 28. ATLS- Primary Survey D-Disability limitation C.N.S. Rapid assessment of motor & sensory functions AVPU A.-Alert V.-Responds to Voice P.-Responds to Pain U.-Unresponsive Pupil.-Size and reaction
- 29. ATLS- Primary Survey D-Disability limitation • Remove remaining clothing • Prevent hypothermia
- 30. CRITICAL DECISIONS Decision making Respondingwell Secondary assessment Transient responders Critical care unit Failure to respond Critical care unit
- 31. Secondary survey (ATLS) •History • Examination • Investigation
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