a simple description on resuscitation and primary survey of trauma - done for humanitarian mission in Acheh

1. DR AHMAD FADZLI BIN SULONG

4. RESUSCITATION AND
PRIMARY MANAGEMENT
OF TRAUMA (OPEN
FRACTURES)

5. RESUSCITATION

6. WHAT IS TRAUMA?
 A serious injury to
the body that
maybe life-
threatening
 Malaysia – mainly
from MVA

7. AIM OF MANAGEMENT
 Prevent death
 Mainly second
peak of death
 GOLDEN
HOUR!

8. STEPS IN MANAGEMENT
Pre – hospital
Triage
Hospital m(x) - ATLS

9. PRE-HOSPITAL
Comprehensive on site
management

10. PRE-HOSPITAL
Moving away from ‘Scoop
and run’ concept!

11. TRIAGE
 A system to sort cases based on priority especially in mass disasters
 Many don’t understand leading to complaints (6 hour UMMC)

12. TRIAGE

15. HOSPITAL M(X) - ATLS CONCEPT
 Introduced by Ortho
surgeon
 Treat the life-
threatening condition
first
 Approach trauma in an
organized and
sequential manner
 Internationally
recognized

16. ATLS CONCEPT

17. PRIMARY SURVEY
 Rapid assessment and treatment of life-threatening injuries
A • Airway (with c-spine)
B • Breathing
C • Circulation
D • Disability
E • Exposure

18. PRIMARY SURVEY

19. A – AIRWAY (WITH C-SPINE)

20. A – AIRWAY (WITH C-SPINE)

21. A – AIRWAY (WITH C-SPINE)
Oropharyngeal airway

22. A – AIRWAY (WITH C-SPINE)

23. B - BREATHING
 A clear airway does not mean the patient is
breathing adequately
 Is required to provide adequate tissue
oxygenation
 Once airway secure, a complete
examination of the lungs MUST be done

24. B - BREATHING
• LOOK
• LISTEN
• FEEL

25. B - BREATHING
LOOK
ANYTACHYPNEA?

26. B - BREATHING
LISTE
N
Abnormal or absent breath sounds

27. B - BREATHING
FEEL
Perform percussion:
Looking for hyper resonance or
dullness

28. B - BREATHING
Tracheal palpation:
Looking for deviation

29. LIFE THREATENING CONDITIONS
 ATOM FC
 Airway obstruction /disruption
 Tension pneumothorax
 Open pneumothorax
 Massive haemathorax
 Flail chest
 Cardiac tamponade

30. B - BREATHING
TENSION
PNEUMOTHORAX:
- No chest excursion
- Absent breath sounds
- Hyper resonance
- Tracheal deviation
away

31. B - BREATHING
Flail chest – paradoxical breathing

32. C - CIRCULATION

33. C - CIRCULATION
Examine for signs of
shock:
- Tachycardia
- Diminished pulse
- Pallor
- Reduce CPR

34. C - CIRCULATION
- Insert 2 large
bore branula
- Send for blood!
- Transfuse!

35. C - CIRCULATION

36. C – CIRCULATION (SCENARIO)

37. C – CIRCULATION (SCENARIO)

38. Where might the injury be?

39. Pelvic binder

40. C-clamp

42. D – DISABILITY

43. E - EXPOSURE
- Not to miss
anything
- Ensure not
hypothermic

44. SECONDARY SURVEY
 History
 Complete physical examination
 ‘tubes and fingers in every orifice’
 Neurological examination
 Re-evaluation