Disability in trauma patient: meaning – and management.pptx
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ABCD approach - D - disability assessment and early management to save life of traumatized patient
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Disability in trauma patient: meaning – and management.pptx
- 1. BY DR. AHMED ABDELTAWAB AZAB Emergency Consultant American Heart Association Instructor Emergency lecturer
- 3. Definition. • Disability: any problem could affect pt. life or limb threat or affect prognosis and out come. • Types: – Neurological. – Metabolic.
- 4. Assessment • Assessment of neurological statues of any pt. done during primary survey by • Use GCS score • Use AVPU score. • Pupil size.
- 8. AVPU score • Easy applicable. • Easy remembering. – A – Alert. – V – respond to Verbal stimulation – P – respond to Painful stimulation. – U – Unresponsive • P score equal 8 score in GCS. • U score equal 3 – 7 score in GCS.
- 10. Pupil examination • Normal pupil with coma exclude intracranial hemorrhage but dose not exclude toxicity. • Bilateral constricted: pin point pupil: • Organophosphorus toxicity. • Opiate toxicity – heroin – cocain. • Pontine hge. • Bilateral dilated fixed pupil: brain death. • Bilateral dilated reactive pupil: • Hallucination drugs – amphetamin
- 12. Pupil examination. • Unilateral dilated pupil: • Intracranial hge : subdural hge .
- 13. Quiz
- 14. Convulsions • Febrile convulsions • Children 1 – 5 years • Simple epilepsy • Less than 5 minutes – regain full consciousness • Status epilepticus • More than 5 - 15 minutes • Not regain consciousness fully between attack
- 15. Convulsions • At home management: – Protect air way – left lateral position – Need for neck collar ?? – Protect from head trauma – Close light – Quit environment. – Post epilepsy state – recovery position. – Safe transfer.
- 16. Convulsions • Medication: – Oral – buccal Lorazepam ½ wt – Rectal diazepam ½ wt. – IV midazolam 1/10 wt – Maximal attempts is twice 20 min. apart. • Antipyretic and fomentation may help in febrile convulsion
- 17. Convulsions • At hospital: – The same like home 1st 2 doses. – If recurrence: start phenytoin – epanutin infusion • 20 mg / kg IV over 30 – 60 minutes – If recurrence: intubation and general anesthesia. – Extra investigations.
- 19. Hypoglycemia: • Management: –Protect airway –If conscious – oral glucose. –If drowsy or unconscious with IV access: –IV dextrose: 50% - 25% - 10% - 5% –If drowsy or unconscious without IV access: –IM glucagon
- 21. Hyperglycemia and DKA • Management: –Fluid –Fluid –Fluid –Insulin –Admission.
- 22. Intoxicated patient. • Do not forget. – Safety for you. – Safety for the patient. – Airway protection. – Decontamination – Rapid transportation. – Antidote.
- 24. Organophosphorus • Management: – Airway – open and suction – Breathing – high flow O2 – intubation. – Circulation – IV access. – Disability – constricted pupils. – Exposure – decontamination – Antidote – atropine IV ??
- 33. Ethylene glycol السيارات راديتير مبرد Ethanol Hemodialysis