This document discusses the treatment of polytrauma patients with airway and circulatory problems. It defines polytrauma as trauma to two or more body systems. It notes that mortality from major vascular or neurological trauma can occur within minutes or hours. The document outlines the ABCDE approach to assessment and treatment - Airway, Breathing, Circulation, Disability, Exposure. It provides examples of treatments for different injuries including tension pneumothorax, chest trauma, hemorrhage control, and neurological assessment.

1. POLYTRAUMA WITH AIRWAY AND CIRCULATORY PROBLEMS Dr. Mansoor Khan MBBS, FCPS I, Resident, Surgical “C”, KTH Peshawar. Sep 29 th , 2009

2. “ Trauma to two or more than two systems of the body with associated signs and symptoms ”

3. Intracranial hematoma, major Thoracic/abdominal trauma Due to sepsis & multi organ failure M o R T A L I T y Within minutes Within Hours (Golden Hour) Within Days or weeks Major Vascular/neurological Trauma Medical treatment usually not helpful

4. Triage 'do the most for the most' T R I A G E

5. TRIAGE White Dead P4 Sprained ankle Delayed Green Minor P3 Fracture femur Urgent Yellow Urgent P2 Tension Pneumothorax Immediate Red Life-Threatening P1 Example Treatment Colour Definition Cat

6. W alk A irway R espiratory rate P ulse rate or C apillary return T R I A G E

7. Triage 2

8. Primary survey and resuscitation A = Airway and cervical spine B = Breathing C = Circulation and haemorrhage control D = Dysfunction of the central nervous system E = Exposure Secondary survey Definitive treatment Call for help A S S E S S M E N t

9. Always assume cervical spine injury If patient can talk then no airway problem If airway compromised initially attempt a chin lift and clear airway of foreign bodies Intubate or cricothyroidotomy Give 100% Oxygen Airway and cervical spine

10. Airway

11. OROPHYRINGEAL AIRWAY

12. Choking

13. ENDOTRACHEAL INTUBATION

14. LMA

16. Check position of trachea, respiratory rate and air entry T ension pneumothorax will need immediate relief Place venous cannula through second intercostal space in the mid-clavicular line If open chest wound seal with occlusive dressing BREATHING

17. PNEUMOTHORAX

18. FLAIL CHEST

19. EMERGENCY DECOMPRESSION

20. EMERGENCY DECOMPRESSION

21. CHEST DRAIN

22. OCCLUSIVE CHEST DRESSING

23. Assess pulse, capillary return and state of neck veins Identify exsanguinating haemorrhage and apply direct pressure Place two large calibre intravenous cannulas Give intravenous fluids (c rystalloid or colloid) Attach patient to ECG monitor Circulation and haemorrhage control

24. Bleeding from hand

25. BLEEDING CONTROL FROM ARM

26. BLEEDING CONTROL FROM GROIN

27. Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive Assess pupil size, equality and responsiveness Dysfunction

28. Avoid hypothermia Fully undress patients Avoid hypothermia Exposure

29. Check all causalities Q uick assess N o moving A pply life-saving treatment

30. Treat in the position found first life-threatening or potentially serious injuries

32. THANKS