Trauma patient, Assessment of trauma patient, care of the patient when arriving in the trauma unit, primary survey, secondary survey

1. EVALUATIONOF
TRAUMAPATIENT
ANIL PATIDAR
ASSISTANT PROFESSOR
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2. OBJECTIVES
To explain the importance of Pre hospital and hospital preparation
Identify the correct sequence of priorities for the assessment of injured
patient.
Explain the principles of primary survey.
Explain need of the immediate resuscitation during primary survey.
Describe initial assessment of the multiply injured patient
Explain the secondary survey.
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3. INTRODUCTION
Injury of one or more systems, that result in
excessive bleeding and may affect the normal
body functioning
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4. PRE HOSPITAL CARE
Ideally is set up to notify the receiving hospital before
personnel transport the patient from the scene
Allows for mobilization of the hospital’s trauma team
members.
Emphasize airway maintenance, control of external
bleeding and shock, immobilization of the patient, and
immediate transport to the closest appropriate facility,
preferably a verified trauma center.
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5. Hospital Phase
Your patient is arriving in 5 Minutes
…….
Do you know where to start?
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6. Primary assessment/
Primary survey
A - Airway (with simultaneous cervical spine stabilization and/or
immobilization)
B Breathing and ventilation
C Circulation and hemorrhage control
D Disability (neurologic status)
E Exposure/ Environmental control
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Find immediate
life-threatening
problems
really quickly

7. Can We Assess A,B,C and
D with in 10 Seconds ?
Asking the patient for His/her name and asking what
happened?
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An appropriate response
( ability to speak clear)
No airway
compromised
Ability to generate air movement to permit
speech
Breathing is not
severely compromised
Alert enough to describe What happened? Level of
consciousness not
markedly decrease
Failure to responds to
questions suggest
Abnormalities in A,B,C,D

8. Airway Precautions
While assessing and managing a patient’s airway, take great
care to prevent excessive movement of the cervical
spine. Based on the mechanism of trauma, assume that a
spinal injury exists
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Never remove a cervical
immobilization
collar until the c-spine has been
cleared
By the MD

9. Airway Assessment
This rapid assessment for signs of airway obstruction includes
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Obstruction
identifying facial,
mandibular, and/or
tracheal/laryngeal
fractures and
• Inspecting airway
for foreign bodies
• result in airway
obstruction
• suctioning to clear
accumulated blood

10. Obstructed Airway
Position the patient
Stabilize the cervical spine
Open and clear the airway
Insert airway
Consider endotracheal intubation
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11. Breathing and Ventilation
Airway patency alone does not ensure adequate
ventilation.
Ventilation requires adequate function of the lungs,
chest wall, and diaphragm; therefore, clinicians must
rapidly examine and evaluate each component.
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12. Breathing assessment
Assess jugular venous distention,
Position of the trachea, and
expose the patient’s neck and chest blunt and penetrating trauma
Spontaneous breathing
Chest rise and fall
Accessory and/or abdominal muscle use
Bilateral breath sounds
tension pneumothorax, massive hemothorax, open pneumothorax,
and tracheal or bronchial injuries should assess during the primary
assessment
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13. Effective breathing Ineffective breathing Absence of breathing
Administer
oxygen via a non
rebreather
mask
• Cyanosis
• Asymmetrical
chest wall
expansion
• Accessory
and/or
abdominal
muscle use
• Paradoxical
movement of
chest wall
• Tracheal shift
from midline
• Jugular vein
distention
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All trauma patients need extra
oxygen, even if They do not
have respiratory system
Compromise
Administer oxygen via non
rebrether mask/ assist in
intubate
Ventilate patient
with bag-valve-
mask with
attached oxygen
reservoir
Endotracheal
Intubation

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A simple pneumothorax
can be converted to a tension
pneumothorax when a
patient is intubated and positive
pressure ventilation
is provided before decompressing the
pneumothorax
with a chest tube.

15. Circulation with
Hemorrhage Control
Circulatory compromise in trauma patients can result from a
variety of injuries. Blood volume, cardiac output, and bleeding are
major circulatory issues to consider.
Hemorrhage is the predominant cause of preventable deaths after
injury.
The elements of clinical observation that yield important
information within seconds are level of consciousness, skin
perfusion, and pulse.
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16. Level of
consciousness
• Due to
decrease blood
volume,
cerebral
perfusion may
impaired result
is an altered
level of
consciousness
Skin Perfusion
• gray facial skin
and pale
extremities
indicates for
hypovolemia
• pink skin,
especially in
the face and
extremities,
rarely has
critical
hypovolemia
Pulse
• A rapid,
thready pulse is
typically sign of
hypovolemia
• Assess a central
pulse(e.g.,
femoral or
carotid artery)
bilaterally for
quality, rate,
and regularity
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17. Bleeding (Circulation ineffective)
Internal bleeding External bleeding
major areas of internal hemorrhage
are the chest, abdomen,
retroperitoneum, pelvis, and long
bones.
identified by physical examination
and imaging (e.g., chest x-ray,
pelvic x-ray,
focused assessment with
sonography for trauma [FAST], or
diagnostic peritoneal lavage
[DPL])
management may include chest
decompression, and application of
a pelvic stabilizing device and/ or
extremity splints
Direct manual pressure on the
wound.
Ineffective
Apply Tourniquets (carry a
risk of ischemic injury to that
extremity.
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18. Definitive bleeding control is essential, along with
appropriate replacement of intravascular
volume.
◦ typically two large-bore peripheral venous catheters are
placed to administer fluid, blood, and plasma.
◦ Obtain blood sample for typing
◦ Administer blood as prescribed
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19. Circulation (Absent)
Begin cardiopulmonary resuscitation (CPR)
Initiate advanced life support (ALS)
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20. Disability (Neurologic
Evaluation)
A rapid neurologic evaluation establishes the patient’s
level of consciousness and pupillary size and reaction;
identifies the presence of lateralizing signs; and
determines spinal cord injury level, if present.
The GCS is a quick, simple, and objective method of
determining the level of consciousness.
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21. Exposure and
Environmental Control
Hypothermia can be present when the patient arrives, or
it may develop quickly in the ED if the patient is uncovered
and undergoes rapid administration of room-temperature
fluids or refrigerated blood.
Hypothermia is lethal complication in injured patients, take
aggressive measures to prevent the loss of body heat and
restore body temperature to normal.
◦ The use of a high-flow fluid warmer to heat crystalloid fluids to
39°C (102.2°F) is recommended
◦ Maintain adequate temperature in resuscitation area
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22. Adjuncts to primary survey
ECG
Pulse oxymetry
Chest X-ray
ABGS
Catheter
Diagnostic peritoneal lavage
Focused abdominal sonogram for trauma
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23. Secondary survey
The secondary survey does not begin until the primary
survey (ABCDE) is completed.
The secondary survey is a head-to-toe evaluation of
the trauma patient—that is, a complete history and
physical examination, including reassessment of all
vital signs
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24. HISTORY
The AMPLE history is a useful mnemonic for this
purpose
•Allergies
•Medications currently used
•Past illnesses/Pregnancy
•Last meal
•Events/Environment related to the injury
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25. Physical Examination
Head-To-Toe Assessment
– Head and face
– Neck
– Chest
– Abdomen and flanks
– Pelvis and perineum
– Extremities
– Posterior surfaces
– General appearance
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26. Glasgow Coma Scale
• Areas of Response
– Eye opening
–Best verbal response
–Best motor response
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27. Adjuncts to Secondary
survey
CT scan
Contrast Studies
Extremity Xray
Endoscopy
USG
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28. Summary
• A Airway (with simultaneous cervical spine stabilization and/or
immobilization)
• B Breathing
• C Circulation
• D Disability (neurologic status)
• E Expose/Environmental control
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29. THANK YOU
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