Polytrauma

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Polytrauma

  1. 1. POLYTRAUMA WITH AIRWAY AND CIRCULATORY PROBLEMS Dr. Mansoor Khan MBBS, FCPS I, Resident, Surgical “C”, KTH Peshawar. Sep 29 th , 2009
  2. 2. “ Trauma to two or more than two systems of the body with associated signs and symptoms ”
  3. 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. 4. Triage 'do the most for the most' T R I A G E
  5. 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. 6. W alk A irway R espiratory rate P ulse rate or C apillary return T R I A G E
  7. 7. Triage 2
  8. 8. <ul><li>Primary survey and resuscitation </li></ul><ul><ul><li>A = Airway and cervical spine </li></ul></ul><ul><ul><li>B = Breathing </li></ul></ul><ul><ul><li>C = Circulation and haemorrhage control </li></ul></ul><ul><ul><li>D = Dysfunction of the central nervous system </li></ul></ul><ul><ul><li>E = Exposure </li></ul></ul><ul><li>Secondary survey </li></ul><ul><li>Definitive treatment </li></ul><ul><li>Call for help </li></ul>A S S E S S M E N t
  9. 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. 10. Airway
  11. 11. OROPHYRINGEAL AIRWAY
  12. 12. Choking
  13. 13. ENDOTRACHEAL INTUBATION
  14. 14. LMA
  15. 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
  16. 17. PNEUMOTHORAX
  17. 18. FLAIL CHEST
  18. 19. EMERGENCY DECOMPRESSION
  19. 20. EMERGENCY DECOMPRESSION
  20. 21. CHEST DRAIN
  21. 22. OCCLUSIVE CHEST DRESSING
  22. 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
  23. 24. Bleeding from hand
  24. 25. BLEEDING CONTROL FROM ARM
  25. 26. BLEEDING CONTROL FROM GROIN
  26. 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
  27. 28. Avoid hypothermia Fully undress patients Avoid hypothermia Exposure
  28. 29. Check all causalities Q uick assess N o moving A pply life-saving treatment
  29. 30. Treat in the position found first life-threatening or potentially serious injuries
  30. 32. THANKS

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