This is a lecture for 5th year medical student in management of severely injured patients

1. PURPOSE OF MEDICAL CARE
 Save life
 Cure from disease
 Prolong survival with disease free period
 Minimize disability
 Protection from disease
 Improve life style
Why we are here …?
We guarantee nothing but our honest effort and care for the patient,
we are not God, but well-trained professionally to take care of
you

2. Management of severely injured patients
Seriously injured patients
 Road traffic accidents
 Car accidents
 Motor cycle
 Falls from height
 Air crashes
 War victims
 Bullet injuries
 Blast injuries
 Natural crises
 Volcanoes
 Earth quick
 Catastrophic fire
Prof. Abdul-hameed jali
Fellow of the royal college of Glasgow ,UK
Consultant surgeon
Head of department of HPB surgery
‫ا‬.‫الجالي‬ ‫الحميد‬ ‫عبد‬ ‫د‬
‫العامه‬ ‫الجراحه‬ ‫استشاري‬
‫المرارية‬ ‫والمسالك‬ ‫والبنكرياس‬ ‫الكبد‬ ‫جراحة‬ ‫قسم‬ ‫رئيس‬
‫الطبي‬ ‫طرابلس‬ ‫مركز‬
By

3.  3242 persons die each day around the world from RTA
 50 million people are disabled or injured each year.
“ Traffic control police department”
Epidemiology
RTA

6. THE IMPORTANCE OF TIME IN TRAUMA IS INCREASING AS
EVIDENT FROM THE EVOLUTION OF THE CONCEPT OF
“ THE PLATINUM TEN MINUTES ”
PLATINUM MINUTES

7. GOLDEN HOUR : The first hour following a trauma
during which aggressive resuscitation can improve
the chances of survival and restore the normal
functions.

8. First 10 minutes
Golden hour

9. Scoop and Run concept

11.  Monitoring vital signs during transport
 Monitoring fluid managements and drugs
Treat the necessary life threatening situations
Inform the recipient casualty about the general
condition of the patient, suspected and sustained
injuries, specialties required.
 Monitoring vital signs during transport
PRE-HOSPITAL INFORMATION AND HANDOVER
Duty of the doctor and paramedical
ambulance attendant

15. Quick assessment in 60 sec
Most senior

37. OPEN PNEUMOTHORAX
Abnormal connection between pleural cavity and atmosphere causing inability to ventilate the lungs
Resuscitation : :
ICD
Oxygenation
Do not transport any patient for radiological investigation ,Prior stabilizing the patient
Do ,
 Portable X rays
 USS
Not:

38. Pneumo – or haemo-thorax , You need to drained by Underwater seal

39. at least two or more adjacent ribs are broken in at least two places .The flail
segment moves in the opposite direction to the rest of the chest wall
Chest Trauma – Flail chest

40. The paradoxical motion observed during respiration with a flail segment

41. The paradoxical motion

43.  BP
 Pulse
 Peripheral perfusion
 General look of the patient

44.  Control bleeding with direct pressure Splint limb fractures
 Insert 2 large bore IV cannulae in adults or cut down on long
saphenous v
 Send off blood-cross match, coagulation screen , Hb, hct,
biochemistry.
 Intraosseous needle in children up to 10 yrs
MANAGEMENT OF CIRCULATION

53. E + M + V = 3 to 15
 less than or equal to 8 are in coma
 Greater than or equal to 9 not in coma
 8 is the critical score:
 Less than or equal to 8 at 6 hours (50% die)
 9 -12 = moderate severity
 Greater than or equal to 13 IS a minor injury
Coma is defined as: the patient is
• Not opening his eyes
• Not obeying the commands
• Not uttering understandable words
Glasgow Coma Scale

57. Special diagnostic tests as indicate
CT
Contrast x-ray studies
Extremity x-ray
Endoscopy
Ultrasound
ADJUNCTS TO SECONDARY SURVEY
 OR
 ICU
 Refer
DEFINITIVE CARE

58.  No proper pre-hospital care
 No trained emergency physicians
 No trained nursing / paramedical staff
 No coordination between different specialties
………………
FACTS!!

59. ‫ل‬ ، ‫هللا‬ ‫لسنا‬ ‫نحن‬ ، ‫بكم‬ ‫والعناية‬ ‫الصادق‬ ‫الجهد‬ ‫سوى‬ ‫ا‬ً‫ئ‬‫شي‬ ‫نضمن‬ ‫ال‬ ‫نحن‬‫مدربون‬ ‫كننا‬
‫بهم‬ ‫والهتما‬ ‫بالمرضى‬ ‫رعاية‬ ‫على‬ ‫جيدا‬ ً‫ا‬‫مهني‬ ً‫ا‬‫تدريب‬
The End