2. An effective trauma system needs the teamwork of EMS, emergency
medicine, trauma surgery, and subspecialists.
A) Pre-hospital phase
Receiving hospital is notified first.
Send to the closest, appropriate facility.
B) In Hospital Phase
Advanced planning for the trauma pt. arrival.
Method to summon extra medical assistance.
Transfer agreement with verified trauma center established.
3. Development of pre-hospital Emergency Medical Services
(EMS) with three purposes:
Get to the patient quickly.
Fix what we can fix .
Quickly get the patient to the right hospital.
4. Golden Hour = 80% of trauma deaths in first hour after injury
Rapid trauma care has greatest level of impact in these patients
4
Immediately Hours Days/Week
50%
30% 20%
5. The "Golden Hour" concept, the period of 60 minutes or less
following injury when immediate definitive care is crucial to a
trauma patient's survival.
6.
7. A. Multiple Casualties :
No. of severity & pt. do not exceed the ability of the facility.
B. Mass Casualties :
No. & severity of pt. exceed the capability of the facility
& staff.
8. Color
Codes
Triage Tag
RED : Most
critical injury.
YELLOW :
Less critical
injured.
GREEN : No
life
threatened
injury.
BLACK :
Death or
obviously
fatal injury.
11. ANATOMICAL
INJURY TO 2/ MORE BODY REGIONS
FRACTURE 2/ MORE LONG BONES
SPINAL CORD INJURY
AMPUTATION OF LIMB
PENETRATING INJURY TO HEAD, NECK TORSO/ PROX. LIMB
BURNS> 15% IN ADULTS, >10% IN CHILDREN, AIRWAY BURNS
AIRWAY OBSTRUCTION
12. PHYSIOLOGICAL
SBP<90mm Hg/ PR- >130 per min.
RR<10/ >30 PER MIN
DEPRESSED CONSCIOUSNESS
AGE>70YR WITH CHEST INJURY
PREGNANCY>24 WEEKS WITH TORSO INJURY
14. Trauma team activation prior to arrival
Name tags worn
Universal precaution in place
Lead gowns in place
X-ray cassette in place
Warmed i.v fluids hanging
O-neg blood ready, blood warmer and rapid infuser ready
Trauma surgeon notified if SBP<90mm Hg
Theatre notified
Radiology notified
15. PRIMARY SURVEY:
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: Neurologic status.
• Exposure/Environmental control.
17. The tertiary survey is a repeat clinical examination along
the lines of the primary and secondary surveys.
It is performed with the aim of identifying injuries that
have been missed during initial assessment.
This survey consists of a structured and comprehensive re-
examination that takes place within 48-72 hours.
18.
19. GCS score of 8 or less.
Inappropriate verbal response.
Protection of the spine.
20. Pt. with maxillofacial or head trauma should be presumed
to have and unstable cervical spine.
The neck should be immobilized until all aspects of the
cervical spine have been adequately studied and an injury
has been excluded.
36. To secure the airway with
direct laryngoscopy,
manual in-line
stabilization (MILS) of
the neck is the standard
care of these patients in
the acute stage.
MILS is best
accomplished by having
two operators in addition
to the physician who is
37.
38.
39. Do not confuse airway problem for ventilation problem
Patent airway does not equal adequate ventilation.
Need good gas exchange
• Oxygen in
• CO2 out
Rapid assessment of
RR
SPO2
TRACHEA
CHEST EXPANSION
PERCUSSION
AUSCULTATION
41. Respiratory Distress
Hyperinflated Chest
Deviated Trachea
Decreased Movement
Decreased Breathsound
Tachycardia
Hypotension
NEEDLE THORACOSTOMY VIA 2ND ICS IN MCL
FOLLOWED BY DEFINITIVE CHEST TUBE (4TH- 5TH ICS JUST
ANTERIOR TO MAL CONNECTED TO WATER UNDER SEAL DRAIN)
42. Signs Similar To Tension Pneumothorax Except Dullness On
Percussion
Shock
T/T- Tube Thoracostomy
• Thoracotomy In
>1500ml DRAIN IMMEDIATELY
>200ml/Hr FOR 4 HOURS
• Contact CTVS Early.
43. Chest Tube At Site Separate To
Defect
Cover Wound With 3 Sides Gauze
Definitive Debridement In OT
44. >2 Rib Fractures
In 2 Or More Places
Paradoxical Chestwall Movement
Adequate Ventilation
Reexpand Lungs: Intubation,,
CTVS Consultation
46. Assess-
• Pulse .
• Skin Colour And Temperature
• Conscious Level(GCS)
• Capillary Refill Time
• Decreased Urine Output
• Hypotension-a Late Sign When≥ 30% Blood Volume Lost.
Stopping The Bleeding : Most Important Priority
47. External hemorrhage
• Apply direct pressure
• No tourniquets except for traumatic amputations
Be aware of possible sources of internal bleeding both from
blunt and penetrating trauma
• Chest
• Abdomen
• Pelvic Fractures
• Long Bone Fractures
48.
49. Primary Survey - Circulation
Table 251-4 Estimated Fluid and Blood Losses Based on Patient's Initial
Presentation
Class I Class
II
Class
III
Class
IV
Blood loss (mL)* Up to 750 750–1500 1500–2000 >2000
Blood loss (percent blood
volume)
Up to 15 15–30 30–40 40
Pulse rate <100 100–120 120–140 >140
Blood pressure Normal Normal Decreased Decreased
Pulse pressure (mm Hg) Normal or
increased
Decreased Decreased Decreased
*Assumes a 70-kg patient with a preinjury circulating blood volume of 5 L.
50. Control bleeding with direct pressure
Splint limb fractures
Insert 2 large bore IV cannulas in adults or cut down on long
saphenous v
Send off blood-cross match,coagulation screen,Hb,
Hct,biochemistry,blood alcohol level if req
Intraosseous needle in children upto 10 yrs
51. Fluid replacement:adults upto 2-3 Lt crystalloid/colloid,
Children- 20 ml/kg
Blood replacement
O neg group specific or fully cross matched packed cells
Remember other blood product requirements: FFP, cryoppt, platelets
52. Elderly - limited ability to increase HR
• BP often has little correlation to Cardiac output
Children - abundant reserve, appear stable then crash
Medication use (Beta Blockers)
54. Simple Mnemonic to describe level of consciousness
• A : Alert
• V : Responds to Vocal stimuli
• P : Responds to Painful stimuli
• U : Unresponsive to all stimuli
55.
56.
57. Spinal cord injury
• High dose steroids if within 8 hours.
ICP monitor- Neurosurgical consultation.
Elevated ICP
• Head of bed elevated
• Mannitol
• Hyperventilation
• Emergent decompression
58. You can’t treat what you don’t find!
If you don’t look, you won’t see!
59.
60.
61. CONTRAINDICATED IN URETHRAL INJURY
SUSPECT URETHRAL INJURY
• INABILITY TO VOID
• UNSTABLE PELVIC FRACTURE
• BLOOD AT MEATUS
• SCROTAL HEMATOMA
• PERINEAL ECCHYMOSIS
• HIGH RIDING PROSTATE
65. The secondary survey does not begin until the primary survey
(ABCDEs) is completed, resuscitative efforts are underway,
and the normalization of vital functions has been demonstrated.
Head to Toe evaluation & reassessment of all vital signs.
AMPLE history