2018 ATLS PROTOCOL
FOCUSING ON THE PRIMORDIAL MANAGEMENT OF PT IN THE APPROACH OF IMPROVING TRAUMA PT MANAGEMENT AND REDUCING MORTALITY OF TRAUMA PT AT OUR RESPECTIVE HEALTH FACILITIES AS DOCTORS AND CLINICIANS WORKING IN THE EMERGENCY DEPARTMENT.
GIVEN THE NECESSARY EQUIPMENT AND FAVOURABLE AMBIENT WORKING ENVIRONMENT WE SHOULD BE ABLE TO OFFER OUR HUMANITY RACE QUALITY SERVICES BEARING IN MIND THAT LIFE COME FIRST AND ALL THE OTHER ATTRIBUTES IN LIFE FOLLOWS
[TRAUMATOLOGY] SOFT TISSUE MANAGEMENT AND RECONSTRUCTION IN ORTHOPAEDICS EMER...Bethwell Radiro
1. Open fractures involve damage to both the bone and surrounding soft tissues, while closed fractures only involve bone damage.
2. Early accurate debridement of traumatic wounds within 24 hours is the most important procedure for managing open lower limb fractures. This involves excising all devitalized tissue.
3. Antibiotics should be administered as soon as possible and surgical debridement and skeletal stabilization is typically performed by orthopaedic and plastic surgeons together within 24 hours, unless there is significant contamination.
The document discusses guidelines for transferring trauma patients to higher levels of care. It recommends identifying the need for transfer as early as possible, stabilizing the patient according to ATLS guidelines before transferring, and acting in the best interest of the patient. Facilities should understand their own capabilities and limitations, involve EMS, follow EMTALA regulations, and have transfer agreements in place. The goal is to transfer patients efficiently while providing the highest possible level of care.
This document discusses methods for triage and assessment in mass casualty situations. It describes evaluating patients based on airway, breathing, circulation, disability and exposure (ATLS methodology). Patients are categorized into triage categories (immediate, delayed, minimal, expectant) based on their injuries and prognosis. Scoring systems like Injury Severity Score (ISS) and Revised Trauma Score (RTS) are used to evaluate patients and compare outcomes between treatment centers using TRISS methodology.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
The document discusses trauma, including terminology, epidemiology, types of trauma, and the roles of trauma nurses. It outlines the ABCDE approach for primary and secondary trauma surveys, emphasizing airway, breathing, circulation, disability, and exposure. It stresses the importance of the golden hour for aggressive resuscitation to improve survival chances and restoring normal function. Trauma nurses play important roles as care providers, educators, and managers working to improve emergency healthcare and prevent injuries.
This document discusses triage, which is the process of sorting patients based on the urgency of their medical condition. It defines triage and outlines its objectives of identifying patients, prioritizing their needs, and directing them to the appropriate care provider. It describes different types of triage including simple, advanced, continuous integrated, and reverse triage. It also discusses under and over triage. The document outlines levels of triage from red to green based on the severity of the patient's condition. Finally, it discusses the role and characteristics of EMTs in effectively performing triage.
A trauma care system is organized to deliver full care to injured patients from the incident to recovery. Common causes of trauma include accidents, violence, and disasters. Clinical manifestations range from pain and hemorrhaging to fractures and psychological impacts. Trauma care management involves phases of triage, resuscitation, secondary survey, stabilization, transfer, and definitive care. The primary survey focuses on life-threatening airway, breathing, circulation, disability, and exposure issues. Secondary survey performs a thorough examination. Trauma care includes interventions like intubation, CPR, and psychological support.
1) The document outlines trauma management protocols, with a focus on spinal cord injuries. It describes the ABCDE approach for initial assessment and management of major trauma patients.
2) It provides details on mechanisms of spinal cord trauma, pre-hospital preparation, secondary evaluations, considerations for special populations, and principles for management during the first 72 hours after injury.
3) The document emphasizes the importance of spine immobilization during transport and stresses that spinal injuries often occur alongside other traumatic injuries, so management must consider the whole clinical picture.
[TRAUMATOLOGY] SOFT TISSUE MANAGEMENT AND RECONSTRUCTION IN ORTHOPAEDICS EMER...Bethwell Radiro
1. Open fractures involve damage to both the bone and surrounding soft tissues, while closed fractures only involve bone damage.
2. Early accurate debridement of traumatic wounds within 24 hours is the most important procedure for managing open lower limb fractures. This involves excising all devitalized tissue.
3. Antibiotics should be administered as soon as possible and surgical debridement and skeletal stabilization is typically performed by orthopaedic and plastic surgeons together within 24 hours, unless there is significant contamination.
The document discusses guidelines for transferring trauma patients to higher levels of care. It recommends identifying the need for transfer as early as possible, stabilizing the patient according to ATLS guidelines before transferring, and acting in the best interest of the patient. Facilities should understand their own capabilities and limitations, involve EMS, follow EMTALA regulations, and have transfer agreements in place. The goal is to transfer patients efficiently while providing the highest possible level of care.
This document discusses methods for triage and assessment in mass casualty situations. It describes evaluating patients based on airway, breathing, circulation, disability and exposure (ATLS methodology). Patients are categorized into triage categories (immediate, delayed, minimal, expectant) based on their injuries and prognosis. Scoring systems like Injury Severity Score (ISS) and Revised Trauma Score (RTS) are used to evaluate patients and compare outcomes between treatment centers using TRISS methodology.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
The document discusses trauma, including terminology, epidemiology, types of trauma, and the roles of trauma nurses. It outlines the ABCDE approach for primary and secondary trauma surveys, emphasizing airway, breathing, circulation, disability, and exposure. It stresses the importance of the golden hour for aggressive resuscitation to improve survival chances and restoring normal function. Trauma nurses play important roles as care providers, educators, and managers working to improve emergency healthcare and prevent injuries.
This document discusses triage, which is the process of sorting patients based on the urgency of their medical condition. It defines triage and outlines its objectives of identifying patients, prioritizing their needs, and directing them to the appropriate care provider. It describes different types of triage including simple, advanced, continuous integrated, and reverse triage. It also discusses under and over triage. The document outlines levels of triage from red to green based on the severity of the patient's condition. Finally, it discusses the role and characteristics of EMTs in effectively performing triage.
A trauma care system is organized to deliver full care to injured patients from the incident to recovery. Common causes of trauma include accidents, violence, and disasters. Clinical manifestations range from pain and hemorrhaging to fractures and psychological impacts. Trauma care management involves phases of triage, resuscitation, secondary survey, stabilization, transfer, and definitive care. The primary survey focuses on life-threatening airway, breathing, circulation, disability, and exposure issues. Secondary survey performs a thorough examination. Trauma care includes interventions like intubation, CPR, and psychological support.
1) The document outlines trauma management protocols, with a focus on spinal cord injuries. It describes the ABCDE approach for initial assessment and management of major trauma patients.
2) It provides details on mechanisms of spinal cord trauma, pre-hospital preparation, secondary evaluations, considerations for special populations, and principles for management during the first 72 hours after injury.
3) The document emphasizes the importance of spine immobilization during transport and stresses that spinal injuries often occur alongside other traumatic injuries, so management must consider the whole clinical picture.
This document discusses disaster surgery and mass casualty incidents. It defines mass casualty incidents as those involving hundreds of casualties that strain local hospital capacity. Disasters can be natural, like earthquakes, or man-made, like accidents or terrorist attacks. When they produce more patients than initial responders can handle, triage is critical to sort patients into categories based on need. The goal of triage is to minimize loss of life by providing the most urgent care first. Fundamental steps in management include assessing airway, breathing, circulation, disability and exposure to stabilize patients.
Triage is the process of prioritizing patients according to the severity of their condition in order to ensure those with the most serious injuries receive care first when resources are limited. It involves classifying patients into categories based on initial assessments and then reassessing as needed. The goal is to do the most good for the most people using available resources. Triage methods like START and SAVE are used in disaster situations to rapidly assess and prioritize patients into categories to determine who should receive immediate care, delayed care, or comfort care only. In the emergency department, a triage team assesses all patients and assigns a color code category of red, yellow, green or black to indicate treatment priority and direct patients to the appropriate care area
The document provides guidance on pre-hospital management of patients with sudden collapse or trauma. It discusses assessing airway, breathing, circulation and disability (ABCD); obtaining a brief history; providing basic life support including CPR if needed; controlling hemorrhage; immobilizing injuries; and initiating intravenous fluids, oxygen, analgesics and antibiotics. Critical issues include inadequate airway, impaired ventilation, significant hemorrhage, abnormal neurological status or injuries to the head, neck or torso. The goal is to stabilize the patient and arrange safe emergency transport.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment and monitoring.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries ranging from minor illnesses to trauma emergencies in patients of all ages.
The document discusses triage in emergency nursing. It defines triage as sorting patients based on acuity to provide the most urgent care first when resources are limited. A triage nurse must quickly identify life-threatening issues and determine each patient's priority level using standardized rating systems. The document outlines the primary and secondary assessments emergency nurses conduct to evaluate patients and identify issues requiring immediate treatment versus those that can wait. The goal of triage is to do the greatest good for the greatest number.
The document provides an overview of an ideal trauma care team structure and roles. It proposes that an ideal trauma care team consists of a team leader, airway specialist, airway assistant, two doctors for assessment and procedures, two nurses for monitoring and circulation, and a scribe. The document outlines the key roles and responsibilities of each member."
START triage, or simple triage and rapid treatment, is a method used by first responders to quickly classify victims during a mass casualty incident based on the severity of their injuries. It involves evaluating victims and assigning them to one of four categories: immediate, delayed, walking wounded/minor, or deceased/expectant. Responders prioritize treatment and evacuation of victims based on their START classification, with immediate victims receiving care first followed by delayed and walking wounded. START provides a standardized process for first responders to rapidly assess and sort large numbers of casualties during an emergency situation.
This document provides an overview of basic trauma life support. It defines trauma as any bodily injury caused by external energy sources. The primary survey involves a quick assessment of the patient's airway, breathing, circulation, disability, and exposure to identify life-threatening issues. The secondary survey involves a more focused physical exam and history to identify hidden injuries. Key skills covered include spinal immobilization, bleeding control techniques, wound management principles like RICE, and splinting. The overall goal is to rapidly identify and treat life-threatening injuries before transporting the patient to definitive care.
3. initial assessment and triage in er pptGirish Kumar
The document discusses the initial assessment and triage of pediatric patients in the emergency room. It outlines the goals of a triage system to rapidly assess patients and prioritize care based on acuity and severity of illness. The pediatric triage assessment involves a rapid 3-5 minute evaluation using the Pediatric Assessment Triangle (PAT) and ABCDE approach to primary assessment. The PAT evaluates appearance, breathing, and circulation within 30-40 seconds to identify life-threatening issues. Patients are then classified into 5 levels of triage acuity from resuscitation to non-urgent to prioritize treatment.
The document provides information on key concepts in emergency nursing. It defines emergency care and the concept of emergency nursing. It outlines the scope and principles of emergency nursing practice. These include establishing airway and ventilation, controlling hemorrhage, and conducting thorough assessments. The document also discusses principles of emergency management, triage, common emergencies like airway obstruction and hemorrhage, and how to manage injuries such as wounds, abdominal trauma, and heat stroke.
The document discusses disaster triage methods for mass casualty incidents with limited resources. It describes the START and SAVE triage protocols. START (Simple Triage and Rapid Treatment) uses respiratory rate, pulse, and mental status to categorize patients as red, yellow, green, or black. SAVE (Secondary Assessment of Victim Endpoint) further assesses patients in a priority order determined by START to allocate limited treatment resources to those with the highest survival probability. The document provides examples of applying both START and SAVE triage protocols to different disaster patients.
The document discusses various aspects of emergency medical services and trauma systems including:
1. It describes the components of a comprehensive trauma system including prehospital care, acute care facilities, specialty care facilities, interfacility transfer, and rehabilitation.
2. It discusses triage principles and methods for single victims and mass casualty incidents including field triage criteria, triage tags, and priority categories.
3. It outlines the emergency department triage process and acuity scale used in Canada to prioritize patients into five levels from resuscitation to non-urgent, based on presenting complaints and sentinel diagnoses.
1. The document discusses the assessment and management of critically ill patients using the ABCDE approach. It outlines the objectives, definitions of critical illness, principles of management, and scoring systems used to evaluate severity of illness.
2. The ABCDE approach involves assessing the airway, breathing, circulation, disability, and exposure/environment. Initial assessment involves stabilizing the patient and identifying life-threatening problems. Further examination is then conducted once the patient is stabilized.
3. Severity of illness scoring systems like APACHE II and SOFA are used to predict outcomes, guide resource allocation, and evaluate quality of care over time. They assess physiological variables and degree of organ dysfunction to determine illness severity.
The document outlines guidelines for treating patients with acute injuries. It recommends treating the most life-threatening problems first, prioritizing patients based on their chance of survival. The guidelines describe performing a primary survey following the ABCDE approach to assess airway, breathing, circulation, disability and exposure, then a secondary survey with a head-to-toe exam including vital signs, history, and physical examination. It also discusses triaging multiple casualties and transferring patients to trauma centers for definitive care.
1) The document discusses disaster medical operations training for CERT members, based on the assumptions that the number of victims could exceed treatment capacity and survivors will need to provide assistance.
2) It outlines the "killers" in emergency medicine - airway obstruction, bleeding, and shock. CERT training focuses on treating these life-threatening conditions through techniques like opening airways, controlling bleeding, and treating for shock.
3) It describes the triage process used to sort and prioritize victims for treatment, including the Immediate, Delayed, Minor, and Dead/Deceased categories. CERT members are trained to conduct triage under simulated disaster conditions.
The document provides guidance on performing an initial patient assessment for EMTs. It describes evaluating the scene for safety, determining the mechanism of injury or nature of illness, and performing an initial assessment of the patient's airway, breathing, circulation, mental status and skin signs. The assessment may be followed by a more focused physical exam and history gathering for medical versus trauma patients. Key steps include maintaining spinal immobilization if needed, assessing vital signs, and identifying any life-threatening conditions requiring immediate treatment.
This document discusses Advanced Trauma Life Support (ATLS), a protocol for trauma care. It outlines the history and growth of ATLS since its introduction in 1988. While ATLS protocols align well with recommendations from reviews of trauma care, the document calls for strengthening ATLS training requirements and ensuring protocols fit current local practice. The future of ATLS would benefit from formal introduction into postgraduate medical education and commitment to ongoing skills retention.
ATLS (Advanced Trauma Life Support) provides guidelines for the initial care and resuscitation of trauma patients. It was introduced in the 1970s and focuses on assessing and treating life-threatening injuries during the "Golden Hour" after trauma occurs. The goals of ATLS are to identify injuries killing the patient, treat those injuries, find all other injuries, and develop a treatment plan. The primary and secondary surveys guide trauma evaluations and focus on the airway, breathing, circulation, disability, and exposure of patients. ATLS aims to optimize trauma care during the critical first hour after injury occurs.
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
The document provides guidance on trauma care and management. It discusses the importance of the golden hour for trauma patients and outlines the steps of the primary survey (ABCDE approach) for rapid assessment and stabilization of patients. These include assessing the airway, breathing, circulation, disability (neurological status), and exposure/environment while preventing hypothermia. Bleeding control and procedures for each component of the primary survey are also described.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document discusses disaster surgery and mass casualty incidents. It defines mass casualty incidents as those involving hundreds of casualties that strain local hospital capacity. Disasters can be natural, like earthquakes, or man-made, like accidents or terrorist attacks. When they produce more patients than initial responders can handle, triage is critical to sort patients into categories based on need. The goal of triage is to minimize loss of life by providing the most urgent care first. Fundamental steps in management include assessing airway, breathing, circulation, disability and exposure to stabilize patients.
Triage is the process of prioritizing patients according to the severity of their condition in order to ensure those with the most serious injuries receive care first when resources are limited. It involves classifying patients into categories based on initial assessments and then reassessing as needed. The goal is to do the most good for the most people using available resources. Triage methods like START and SAVE are used in disaster situations to rapidly assess and prioritize patients into categories to determine who should receive immediate care, delayed care, or comfort care only. In the emergency department, a triage team assesses all patients and assigns a color code category of red, yellow, green or black to indicate treatment priority and direct patients to the appropriate care area
The document provides guidance on pre-hospital management of patients with sudden collapse or trauma. It discusses assessing airway, breathing, circulation and disability (ABCD); obtaining a brief history; providing basic life support including CPR if needed; controlling hemorrhage; immobilizing injuries; and initiating intravenous fluids, oxygen, analgesics and antibiotics. Critical issues include inadequate airway, impaired ventilation, significant hemorrhage, abnormal neurological status or injuries to the head, neck or torso. The goal is to stabilize the patient and arrange safe emergency transport.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment and monitoring.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries ranging from minor illnesses to trauma emergencies in patients of all ages.
The document discusses triage in emergency nursing. It defines triage as sorting patients based on acuity to provide the most urgent care first when resources are limited. A triage nurse must quickly identify life-threatening issues and determine each patient's priority level using standardized rating systems. The document outlines the primary and secondary assessments emergency nurses conduct to evaluate patients and identify issues requiring immediate treatment versus those that can wait. The goal of triage is to do the greatest good for the greatest number.
The document provides an overview of an ideal trauma care team structure and roles. It proposes that an ideal trauma care team consists of a team leader, airway specialist, airway assistant, two doctors for assessment and procedures, two nurses for monitoring and circulation, and a scribe. The document outlines the key roles and responsibilities of each member."
START triage, or simple triage and rapid treatment, is a method used by first responders to quickly classify victims during a mass casualty incident based on the severity of their injuries. It involves evaluating victims and assigning them to one of four categories: immediate, delayed, walking wounded/minor, or deceased/expectant. Responders prioritize treatment and evacuation of victims based on their START classification, with immediate victims receiving care first followed by delayed and walking wounded. START provides a standardized process for first responders to rapidly assess and sort large numbers of casualties during an emergency situation.
This document provides an overview of basic trauma life support. It defines trauma as any bodily injury caused by external energy sources. The primary survey involves a quick assessment of the patient's airway, breathing, circulation, disability, and exposure to identify life-threatening issues. The secondary survey involves a more focused physical exam and history to identify hidden injuries. Key skills covered include spinal immobilization, bleeding control techniques, wound management principles like RICE, and splinting. The overall goal is to rapidly identify and treat life-threatening injuries before transporting the patient to definitive care.
3. initial assessment and triage in er pptGirish Kumar
The document discusses the initial assessment and triage of pediatric patients in the emergency room. It outlines the goals of a triage system to rapidly assess patients and prioritize care based on acuity and severity of illness. The pediatric triage assessment involves a rapid 3-5 minute evaluation using the Pediatric Assessment Triangle (PAT) and ABCDE approach to primary assessment. The PAT evaluates appearance, breathing, and circulation within 30-40 seconds to identify life-threatening issues. Patients are then classified into 5 levels of triage acuity from resuscitation to non-urgent to prioritize treatment.
The document provides information on key concepts in emergency nursing. It defines emergency care and the concept of emergency nursing. It outlines the scope and principles of emergency nursing practice. These include establishing airway and ventilation, controlling hemorrhage, and conducting thorough assessments. The document also discusses principles of emergency management, triage, common emergencies like airway obstruction and hemorrhage, and how to manage injuries such as wounds, abdominal trauma, and heat stroke.
The document discusses disaster triage methods for mass casualty incidents with limited resources. It describes the START and SAVE triage protocols. START (Simple Triage and Rapid Treatment) uses respiratory rate, pulse, and mental status to categorize patients as red, yellow, green, or black. SAVE (Secondary Assessment of Victim Endpoint) further assesses patients in a priority order determined by START to allocate limited treatment resources to those with the highest survival probability. The document provides examples of applying both START and SAVE triage protocols to different disaster patients.
The document discusses various aspects of emergency medical services and trauma systems including:
1. It describes the components of a comprehensive trauma system including prehospital care, acute care facilities, specialty care facilities, interfacility transfer, and rehabilitation.
2. It discusses triage principles and methods for single victims and mass casualty incidents including field triage criteria, triage tags, and priority categories.
3. It outlines the emergency department triage process and acuity scale used in Canada to prioritize patients into five levels from resuscitation to non-urgent, based on presenting complaints and sentinel diagnoses.
1. The document discusses the assessment and management of critically ill patients using the ABCDE approach. It outlines the objectives, definitions of critical illness, principles of management, and scoring systems used to evaluate severity of illness.
2. The ABCDE approach involves assessing the airway, breathing, circulation, disability, and exposure/environment. Initial assessment involves stabilizing the patient and identifying life-threatening problems. Further examination is then conducted once the patient is stabilized.
3. Severity of illness scoring systems like APACHE II and SOFA are used to predict outcomes, guide resource allocation, and evaluate quality of care over time. They assess physiological variables and degree of organ dysfunction to determine illness severity.
The document outlines guidelines for treating patients with acute injuries. It recommends treating the most life-threatening problems first, prioritizing patients based on their chance of survival. The guidelines describe performing a primary survey following the ABCDE approach to assess airway, breathing, circulation, disability and exposure, then a secondary survey with a head-to-toe exam including vital signs, history, and physical examination. It also discusses triaging multiple casualties and transferring patients to trauma centers for definitive care.
1) The document discusses disaster medical operations training for CERT members, based on the assumptions that the number of victims could exceed treatment capacity and survivors will need to provide assistance.
2) It outlines the "killers" in emergency medicine - airway obstruction, bleeding, and shock. CERT training focuses on treating these life-threatening conditions through techniques like opening airways, controlling bleeding, and treating for shock.
3) It describes the triage process used to sort and prioritize victims for treatment, including the Immediate, Delayed, Minor, and Dead/Deceased categories. CERT members are trained to conduct triage under simulated disaster conditions.
The document provides guidance on performing an initial patient assessment for EMTs. It describes evaluating the scene for safety, determining the mechanism of injury or nature of illness, and performing an initial assessment of the patient's airway, breathing, circulation, mental status and skin signs. The assessment may be followed by a more focused physical exam and history gathering for medical versus trauma patients. Key steps include maintaining spinal immobilization if needed, assessing vital signs, and identifying any life-threatening conditions requiring immediate treatment.
This document discusses Advanced Trauma Life Support (ATLS), a protocol for trauma care. It outlines the history and growth of ATLS since its introduction in 1988. While ATLS protocols align well with recommendations from reviews of trauma care, the document calls for strengthening ATLS training requirements and ensuring protocols fit current local practice. The future of ATLS would benefit from formal introduction into postgraduate medical education and commitment to ongoing skills retention.
ATLS (Advanced Trauma Life Support) provides guidelines for the initial care and resuscitation of trauma patients. It was introduced in the 1970s and focuses on assessing and treating life-threatening injuries during the "Golden Hour" after trauma occurs. The goals of ATLS are to identify injuries killing the patient, treat those injuries, find all other injuries, and develop a treatment plan. The primary and secondary surveys guide trauma evaluations and focus on the airway, breathing, circulation, disability, and exposure of patients. ATLS aims to optimize trauma care during the critical first hour after injury occurs.
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
The document provides guidance on trauma care and management. It discusses the importance of the golden hour for trauma patients and outlines the steps of the primary survey (ABCDE approach) for rapid assessment and stabilization of patients. These include assessing the airway, breathing, circulation, disability (neurological status), and exposure/environment while preventing hypothermia. Bleeding control and procedures for each component of the primary survey are also described.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
The document outlines the history and development of Advanced Trauma Life Support (ATLS). It describes the initial assessment process for trauma patients, including the primary and secondary surveys, with a focus on identifying and treating life-threatening injuries immediately. Specific types of injuries are discussed such as head trauma, thoracic trauma, abdominal/pelvic trauma. The goal of ATLS is to provide a standardized approach to trauma care through systematic assessment and simultaneous resuscitation to reduce mortality from traumatic injuries.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
This document provides an overview of primary care in trauma. It discusses the trimodal distribution of trauma deaths, the concept and principles of ATLS (Advanced Trauma Life Support), and the ABCDE approach to the initial assessment and management of trauma patients. Key steps include preparing the trauma team, conducting an initial assessment including primary and secondary surveys, and providing definitive care such as establishing an airway, controlling bleeding, and treating specific injuries. Special populations like children and the elderly require special considerations.
The document discusses the primary survey and initial assessment of trauma patients. It outlines the steps as preparation, triage, primary survey (ABCDEs) with immediate resuscitation, secondary survey, and continued monitoring. The primary survey focuses on airway, breathing, circulation, disability, and exposure. Steps include maintaining the airway while restricting neck motion, assessing breathing, treating injuries impairing ventilation, and evaluating circulation and controlling hemorrhage.
Maxillofacial injuries are common in polytrauma patients and can range from minor to life-threatening. The document discusses the primary assessment and management of maxillofacial trauma patients, which begins with the ABCDE approach. It is important to first secure the airway while maintaining cervical spine control, and then assess breathing and ventilation. Next, circulation and hemorrhage control are evaluated, followed by disability assessment. Finally, the patient's exposure is addressed and they are monitored for adequate oxygenation. The primary survey focuses on rapidly identifying and treating conditions that could lead to early mortality or morbidity.
Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
The document discusses guidelines for safely transporting critically ill patients within the hospital. It notes that transport increases risks from disconnecting life support equipment and monitoring. To minimize risks, transports require careful planning, qualified personnel, and appropriate equipment. The guidelines recommend at least two trained caregivers accompany patients, along with vital sign monitors, ventilation equipment, emergency drugs, IV pumps and backups. Ongoing communication and matching the pre-transport level of care and monitoring during transport are also emphasized. The document concludes that following these guidelines can help reduce adverse events, which occur in 6-71% of transports without interventions.
The document discusses peri-operative nursing management. It describes the three phases of peri-operative care - pre-operative, intra-operative, and post-operative. In the pre-operative phase, nurses complete assessments, education, and prepare patients for surgery. During surgery, nurses monitor patients and ensure safety. In post-operation, nurses in recovery areas and surgical units assess patients, manage pain, and prepare for discharge. Potential complications are also classified and discussed.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
Advanced trauma life support, management of a polytrauma patientLawrenceWanderi
The document outlines the objectives and procedures of the Advanced Trauma Life Support (ATLS) protocol for rapidly assessing and stabilizing patients. It describes the "golden hour" window for treatment, and conducting an initial assessment including primary and secondary surveys, with resuscitation of life-threatening injuries and consideration of patient transfer needs. The primary survey involves assessing the ABCDEs (airway, breathing, circulation, disability, exposure) while the secondary survey is a full physical exam and history. Adjuncts aid diagnosis while continual reassessment is important for trauma patients.
Advanced trauma and life support (atls)anu_sandhya
The document outlines the steps of the Advanced Trauma Life Support (ATLS) protocol for assessing and treating multiply injured patients, including performing a primary and secondary survey to evaluate the airway, breathing, circulation, disability, and exposure of patients and providing resuscitation and monitoring before delivering definitive care. It emphasizes following the ABCDE approach to treat the greatest threats to life first and stabilizing patients before making a definitive diagnosis.
Dr. Mohamed El Sayed is a lecturer of anesthesia and intensive care and manages a surgical intensive care unit at Zagazig University Hospitals. He outlines the key steps in treating trauma patients, which include coordinating pre-hospital care, performing triage based on ABC priorities of airway, breathing, and circulation, conducting primary and secondary surveys to assess injuries and monitor vital signs, and providing ongoing reevaluation to detect new issues or deterioration. The goal is to identify and treat life-threatening injuries while preventing secondary complications through careful resuscitation and monitoring of trauma patients.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment decisions.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries, from minor illnesses to trauma, for patients of all ages.
Management Of Patient Undergoing Surgerykalyan kumar
The document discusses the management of patients undergoing surgery. It covers the three main phases of surgical management: pre-operative, intra-operative, and post-operative management. For pre-operative management, the document outlines the physical, psychosocial, physiological preparations and assessments a patient undergoes before surgery including examinations, investigations, pre-medications. It then briefly describes the roles of the surgical team during intra-operative management. Finally, it discusses the immediate post-operative recovery phase in PACU and management of common post-operative complications.
This document summarizes postoperative nursing care, including care in the post-anesthesia care unit (PACU). It discusses phases of PACU care, initial nursing assessment, possible nursing diagnoses, interventions to maintain cardiovascular and respiratory stability, promoting wound healing, and phases of wound healing.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. After reading this chapter and comprehending the knowledge components of the ATLS provider course, you
will be able to:
1. Explain the importance of prehospital and hospital preparation to facilitate rapid resuscitation of trauma
patients.
2. Identify the correct sequence of priorities for the assessment of injured patients.
3. Explain the principles of the primary survey, as they apply to the assessment of an injured patient.
4. Explain how a patient’s medical history and the mechanism of injury contribute to the identification of injuries.
5. Explain the need for immediate resuscitation during the primary survey.
6. Describe the initial assessment of a multiply injured patient, using the correct sequence of priorities.
7. Identify the pitfalls associated with the initial assessment and management of injured patients and describe ways
to avoid them.
3. 8. Explain the management techniques employed during the primary assessment
and stabilization of a multiply injured patient.
9. Identify the adjuncts to the assessment and management of injured patients as
part of the primary survey, and recognize the contraindications to their use.
10. Recognize patients who require transfer to another facility for definitive
management.
11. Identify the components of a secondary survey, including adjuncts that may be
appropriate during its performance.
12. Discuss the importance of reevaluating a patient who is not responding
appropriately to resuscitation and management.
13. Explain the importance of teamwork in the initial assessment of trauma
patients.
4. clinicians rapidly assess injuries and institute life preserving therapy, using initial assessment approach;
Preparation
Triage
Primary survey [A.B.C.D.E.s] with immediate resuscitation of patients with life threatening injuries
Adjuncts to primary survey and resuscitation
Consideration of the need of patient referral
Secondary survey [head to toe evaluation and patient history]
Adjuncts to secondary survey
Continued post resuscitation monitoring and re-evaluation
Definitive care
NB; The primary and secondary surveys are repeated frequently to identify any change in the patient’s status
that indicates the need for additional intervention.
ATLS principles guide the assessment and resuscitation of injured patients. Judgment is required to
determine which procedures are necessary for individual patients, as they may not require all of them
5. Preparation for trauma patients occurs in two
different clinical settings:
1.Pre hospital phase
2.Hospital phase
6. Notification of the receiving facility – to enable mobilization of trauma team
at the emergency department [E.D]
B.L.S procedures ;airway maintenance, control of external bleeding and shock,
immobilization of the patient
Minimizing the scene time
Emphasis on obtaining and reporting information needed to triage at the
hospital; time of injury, mechanism of injury, events related to the injury, and
patient history
7. The referring personnel to follow pre-alert check list
Smooth handing over directed by trauma leader
Critical aspect of hospital preparation should be in place and these include;
1.Resuscitation area
2.Proper functioning equipment's ,organized, tested and strategically placed for easy accessibility
3.Back up team in place and prompt response from the laboratory and the radiology team
4.Transfer agreements with verified trauma center
NB; all medical personnel should be in a proper protective gear to prevent transmission of
communicable diseases
8. Usually done based on resources required for treatment and the resources that are available. Appropriate
patient for appropriate facility. Thus can be initiated at the pre hospital phase
Factors affecting triage include ;severity of injury, ability to survive and available resources
Categorized into;
a) Multiple casualties - the number of patients and the severity of their injuries do not exceed the
capability of the facility to render care. In such cases, patients with life-threatening problems and those
sustaining multiple-system injuries are treated first.
b) Mass casualties - the number of patients and the severity of their injuries does exceed the capability of
the facility and staff. In such cases, patients having the greatest chance of survival and requiring the
least expenditure of time, equipment, supplies, and personnel are treated first
9. Encompasses the A.B.C.D.E of trauma care and identifies life threatening condition
adhering to the sequence;
Airway maintenance with restriction of cervical spine motion
Breathing and ventilation
Circulation with hemorrhage control
Disability(assessment of neurologic status)
Exposure/Environmental control
Clinicians can quickly assess A, B, C, and D in a trauma patient (10-second assessment) by
identifying themselves, asking the patient for his or her name, and asking what happened.
Appropriate response means;
I. breathing is not severely compromised
II. the level of consciousness is not markedly decreased
During the primary survey, life-threatening conditions are identified and treated in a prioritized
sequence based on the effects of injuries on the patient’s physiology, because at first it may
not be possible to identify specific anatomic injuries.
10. ascertain patency
assessment for signs of airway obstruction includes inspecting for foreign bodies; identifying facial,
mandibular, and/or tracheal/laryngeal fractures and other injuries that can result in airway
obstruction
suctioning to clear accumulated blood or secretions that may lead to or be causing airway
obstruction
restricting cervical spine motion.
patients with severe head injuries who have G.C.S. score of 8 or lower and non purposeful motor
response usually require the placement of a definitive airway
Initially, the jaw-thrust or chin-lift maneuver often suffices as an initial intervention
Placement of oropharengeal airway can be helpful in unconscious patients with no gag reflex
NB; Establish a definitive airway if there is any doubt about the patient’s ability to maintain airway
integrity.
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. Neurologic
examination alone does not exclude a diagnosis of cervical spine injury
Restrictions is done with a cervical collar
Establish an airway surgically if intubation is contraindicated or cannot be accomplished.
11. Ventilation requires adequate function of the lungs, chest wall, and diaphragm; therefore,
clinicians must rapidly examine and evaluate each component.
To adequately assess jugular venous distention, position of the trachea, and chest wall
excursion, expose the patient’s neck and chest
Perform auscultation to ensure gas flow in the lungs.
Visual inspection and palpation can detect injuries to the chest wall that may be
compromising ventilation.
Percussion of the thorax can also identify abnormalities, but during a noisy resuscitation this
evaluation may be inaccurate.
Injuries that significantly impair ventilation in the short term include tension pneumothorax,
massive hemothorax, open pneumothorax, and tracheal or bronchial injuries.
Every injured patient should receive supplemental oxygen.
Use a pulse oximeter to monitor adequacy of hemoglobin oxygen saturation.
NB. 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.;
12. . Blood volume, cardiac output, and bleeding are major circulatory issues
consider.
Rapid and accurate assessment of an injured patient’s hemodynamic status
essential.
13. The elements of clinical observation that yield important information within seconds are;
1. Level of Consciousness—When circulating blood volume is reduced, cerebral perfusion may be critically
impaired, resulting in an altered level of consciousness.
2. Skin Perfusion—This sign can be helpful in evaluating injured hypovolemic patients. A patient with pink
skin, especially in the face and extremities, rarely has critical hypovolemia after injury. Conversely, a patient
with hypovolemia may have ashen, gray facial skin and pale extremities.
3. Pulse—A rapid, thready pulse is typically a sign of hypovolemia. Assess a central pulse (e.g., femoral or
carotid artery) bilaterally for quality, rate, and regularity. Absent central pulses that cannot be attributed to
local factors signify the need for immediate resuscitative action.
14. Identify the source of bleeding as external or internal.
Caution on the use of tourniquets and blind clamping cause it can lead to ischemic
injury and neurovascular bundle injury respectively
major areas of internal hemorrhage are the chest, abdomen, retroperitoneum, pelvis,
and long bones. usually 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.
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. , intraosseous infusion, central venous access, or venous cutdown
may be used depending on the patient’s injuries and the clinician’s skill level, when
peripheral site can not be accesed
15. Blood samples for baseline hematologic studies are obtained, including a pregnancy
test for all females of childbearing age and blood type and cross matching.
. To assess the presence and degree of shock, blood gases and/or lactate level are
obtained
NB; Aggressive and continued volume resuscitation is not a substitute for definitive
control of hemorrhage.
All IV solutions should be warmed either by storage in a warm environment (i.e.,
37°C to 40°C, or 98.6°F to 104°F) or administered through fluidwarming devices.
Preferable crystalloids
A bolus of 1 L of an isotonic solution may be required to achieve an appropriate
response in an adult patient. If patient unresponsive with the initial crystalloid
therapy he should receive blood transfusion so as to prevent hemodilution
Coagulopathy which is one of the risk in trauma patients can be mitigated by use of
massive transfusion protocols with blood components administered at predefined
low ratios
tranexamic acid is administered within 3 hours of injury. When bolused in the field
follow up infusion is given over 8 hours in the hospital
16.
17. A rapid neurologic evaluation establishes the patient’s level of consciousness and
pupillary size and reaction
The GCS is a quick, simple, and objective method of determining the level of
consciousness.
An altered level of consciousness indicates the need to immediately reevaluate the
patient’s oxygenation, ventilation, and perfusion status.
Hypoglycemia, alcohol, narcotics, and other drugs can also alter a patient’s level of
consciousness.
Until proven otherwise, always presume that changes in level of consciousness are a
result of central nervous system injury.
. Patients with evidence of brain injury should be treated at a facility that has the
personnel and resources to anticipate and manage the needs of these patients.
When resources to care for these patients are not available arrangements for transfer
should begin as soon as this condition is recognized.
consult a neurosurgeon once a brain injury is recognized.
18.
19. During the primary survey, completely undress the patient, usually by cutting
off his or her garments to facilitate a thorough examination and assessment.
NB; 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. Because
hypothermia is a potentially lethal complication in injured patients, take
aggressive measures to prevent the loss of body heat and restore body
temperature to normal
. The patient’s body temperature is a higher priority than the comfort of the
healthcare providers, and the temperature of the resuscitation area should be
increased to minimize the loss of body heat.
20. include continuous electrocardiography, pulse oximetry, carbon dioxide (CO2 )
monitoring, and assessment of ventilatory rate, and arterial blood gas (ABG)
measurement.
urinary catheters can be placed to monitor urine output and assess for
hematuria.
Gastric catheters decompress distention and assess for evidence of blood.
Other helpful tests include blood lactate, x-ray examinations (e.g., chest and
pelvis), FAST, extended focused assessment with sonography for trauma
(eFAST), and DPL.
Physiologic parameters such as pulse rate, blood pressure, pulse pressure,
ventilatory rate, ABG levels, body temperature, and urinary output are
assessable measures that reflect the adequacy of resuscitation. Values for
these parameters should be obtained as soon as is practical during or after
completing the primary survey, and reevaluated periodically.
21. Electrocardiographic (ECG) monitoring of all trauma patients is important.
Dysrhythmias—including unexplained tachycardia, atrial fibrillation, premature
ventricular contractions, and ST segment changes—can indicate blunt cardiac
injury.
Pulseless electrical activity (PEA) can indicate cardiac tamponade, tension
pneumothorax, and/or profound hypovolemia.
bradycardia, aberrant conduction, and premature beats are present, hypoxia
and hypoperfusion should be suspected immediately.
Extreme hypothermia also produces dysrhythmias.
22. The relative absorption of light by oxyhemoglobin (HbO) and deoxyhemoglobin
is assessed by measuring the amount of red and infrared light emerging from
tissues traversed by light rays and processed by the device, producing an
oxygen saturation level
Pulse oximetry does not measure the partial pressure of oxygen or carbon
dioxide.
hemoglobin saturation from the pulse oximeter should be compared with the
value obtained from the ABG analysis
23. Ventilatory rate, capnography, and ABG measurements are used to monitor the
adequacy of the patient’s respirations.
colorimetry, capnometry, or capnography—a noninvasive monitoring technique
that provides insight into the patient’s ventilation, circulation, and metabolism.
can be used to confirm intubation of the airway
End tidal CO2 can also be used for tight control of ventilation to avoid
hypoventilation and hyperventilation. It reflects cardiac output and is used to
predict return of spontaneous circulation(ROSC) during CPR.
ABG values provide acid base information.
low pH and base excess levels indicate shock; therefore, trending these values
can reflect improvements with resuscitation.
24. The placement of urinary and gastric catheters occurs
during or following the primary survey.
25. a sensitive indicator of the patient’s volume status and reflects renal perfusion
accomplished by insertion of an indwelling bladder catheter after examining
the perineum and genitalia . Transurethral bladder catheterization is
contraindicated for patients who may have urethral injury.
Suspect a urethral injury in the presence of either blood at the urethral meatus
or perineal ecchymosis. confirm urethral integrity by performing a retrograde
urethrogram before the catheter is inserted
a urine specimen should be submitted for routine laboratory analysis.
At times anatomic abnormalities (e.g., urethral stricture or prostatic
hypertrophy) preclude placement of indwelling bladder catheters, despite
appropriate technique.
Consult a urologist early
26. is indicated to decompress stomach distention, decrease the risk of aspiration
[does not prevent it entirely], and check for upper gastrointestinal hemorrhage
from trauma.
. Thick and semisolid gastric contents will not return through the tube, and
placing the tube can induce vomiting
effective only if it is properly positioned and attached to appropriate suction.
Blood in the gastric aspirate may indicate oropharyngeal (i.e., swallowed)
blood, traumatic insertion, or actual injury to the upper digestive tract.
If a fracture of the cribriform plate is known or suspected, insert the gastric
tube orally to prevent intracranial passage. Reason being that any
nasopharyngeal instrumentation is potentially dangerous, and an oral route is
recommended.
27. Anteroposterior (AP) chest rays [can show potentially life-threatening injuries
that require treatment or further investigation] and AP pelvic films [can show
fractures of the pelvis that may indicate the need for early blood transfusion]
guides resuscitation efforts of patients with blunt trauma.
Use of a portable x-ray unit is advices if available, but shouldn't interrupt the
resuscitation process
Do obtain essential diagnostic x-rays in pregnant patients
FAST, eFAST, and DPL [challenging to perform in pregnant, have had prior
laparotomies or obese] are useful tools for quick detection of intraabdominal
blood, pneumothorax, and hemothorax. General surgeon should be consulted in
such instance
The finding of intraabdominal blood indicates the need for surgical intervention
in hemodynamically abnormal patients.
28. It is important not to delay transfer to perform an indepth diagnostic
evaluation. Only undertake testing that enhances the ability to resuscitate,
stabilize, and ensure the patient’s safe transfer.
communication between the referring and receiving doctors is essential.
29. Includes; children, pregnant women, older adults, obese patients, and
athletes
Priorities for the care of these patients are the same as for all trauma
patients, but these individuals may have physiologic responses that do
not follow expected patterns and anatomic differences that require
special equipment or consideration.
30. have unique physiology and anatomy
The quantities of blood, fluids, and medications vary with the size of
the child.
the injury patterns and degree and rapidity of heat loss differ.
Children typically have abundant physiologic reserve and often have
few signs of hypovolemia, even after severe volume depletion.
31. The anatomic and physiologic changes of pregnancy can modify the
patient’s response to injury
Early recognition of pregnancy by palpation of the abdomen for a
gravid uterus and laboratory testing (e.g., human chorionic
gonadotropin [hCG]), as well as early fetal assessment, are important
for maternal and fetal survival.
Vaginal ph should be done to role out amneotic fluid leakage
32. The aging process diminishes the physiologic reserve of these patients, and
chronic cardiac, respiratory, and metabolic diseases can impair their ability
to respond to injury in the same manner as younger patients.
Comorbidities such as diabetes, congestive heart failure, coronary artery
disease, restrictive and obstructive pulmonary disease, coagulopathy, liver
disease, and peripheral vascular disease are more common in older patients
and may adversely affect outcomes following injury.
long-term use of medications can alter the usual physiologic response to
injury and frequently leads to over-resuscitation or under-resuscitation in
this patient population
33. their anatomy can make procedures such as intubation difficult and
hazardous
Diagnostic tests such as FAST, DPL, and CT are also more difficult.
many obese patients have cardiopulmonary disease, which limits their
ability to compensate for injury and stress.
34. may not manifest early signs of shock, such as tachycardia and
tachypnea
They may also have normally low systolic and diastolic blood pressure.
35. is a head-to-toe evaluation of the trauma patient—that is, a complete
history and physical examination, including reassessment of all vital
signs.
The secondary survey does not begin until the primary survey (ABCDE)
is completed, resuscitative efforts are under way, and improvement of
the patient’s vital functions has been demonstrated.
When additional personnel are available, part of the secondary survey
may be conducted while the other personnel attend to the primary
survey. This method must in no way interfere with the performance of
the primary survey, which is the highest priority.
Each region of the body is completely examined.
36. Usually obtained from the prehospital personnel and family memmbers
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
Knowledge of the mechanism of injury can enhance understanding of the
patient’s physiologic state and provide clues to anticipated injuries
Injuries are divided into two broad categories: blunt and penetrating trauma
Other types of injuries for which historical information is important include
thermal injuries and those caused by hazardous environments.
37. results from automobile collisions, falls, and other injuries related to
transportation, recreation, interpersonal violence, and occupations.
Important information to obtain about automobile collisions includes seat-belt
use, steering wheel deformation, presence and activation of air-bag devices,
direction of impact, damage to the automobile in terms of major deformation
or intrusion into the passenger compartment, and patient position in the
vehicle
Ejection from the vehicle greatly increases the possibility of major injury
38. factors that determine the type and extent of injury and subsequent
management include the body region that was injured, organs in the
path of the penetrating object, and velocity of the missile.
in gunshot victims, the velocity, caliber, presumed path of the bullet,
and distance from the weapon to the wound can provide important
clues regarding the extent of injury
39. can occur alone or in conjunction with blunt and/or penetrating trauma
Inhalation injury and carbon monoxide poisoning often complicate burn
injuries.
Information regarding the circumstances of the burn injury can increase the
index of suspicion for inhalation injury or toxic exposure from combustion of
plastics and chemicals.
Acute or chronic hypothermia without adequate protection against heat
loss produces either local or generalized cold injuries. if wet clothes,
decreased activity, and/or vasodilation caused by alcohol or drugs
compromise the patient’s ability to conserve heat - (15°C to 20°C or 59°F to
68°F)
40. A history of exposure to chemicals, toxins, and radiation is important
to obtain for two main reasons: These agents can produce a variety of
pulmonary, cardiac, and internal organ dysfunctions in injured
patients, and they can present a hazard to healthcare providers.
41. physical examination follows the sequence of
1. head
2. maxillofacial structures
3. cervical spine and neck
4. chest
5. abdomen and pelvis
6. perineum/rectum/vagina
7. musculoskeletal system
8. neurological system.
42. identify all related neurologic injuries and any other significant injuries.
The entire scalp and head should be examined for lacerations, contusions, and
evidence of fractures.
the eyes should be reevaluated for:
a)Visual acuity
b) Pupillary size
c)Hemorrhage of the conjunctiva and/or fundi
d)Penetrating injury
e) Contact lenses (remove before edema occurs)
f) Dislocation of the lens
g) Ocular entrapment
quick visual acuity examination of both eyes by asking the patient to read handheld Snellen chart or words
on a piece of equipment
Ocular mobility should be evaluated to exclude entrapment of extraocular muscles due to orbital fractures
43. include palpation of all bony structures, assessment of occlusion,
intraoral examination, and assessment of soft tissues.
Maxillofacial trauma that is not associated with airway obstruction or
major bleeding should be treated only after the patient is stabilized
and life-threatening injuries have been managed.
Patients with fractures of the midface may also have a fracture of the
cribriform plate for these patients gastric intubation should be
performed via the oral route
44. Patients with maxillofacial or head trauma should be presumed to have a cervical spine injury (e.g.,
fracture and/or ligament injury), and cervical spine motion must be restricted
The absence of neurologic deficit does not exclude injury to the cervical spine, and such injury should
be presumed until evaluation of the cervical spine is completed
Radiographic evaluation can be avoided in patients who meet The National Emergency X-
Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) or Canadian C-Spine Rule (CCR).
Examination of the neck includes inspection, palpation, and auscultation
can present with coma or without neurologic finding. CT angiography, angiography, or duplex
ultrasonography may be required to exclude the possibility of major cervical vascular injury when the
mechanism of injury suggests this possibility.
Protection of a potentially unstable cervical spine injury is imperative for patients who are wearing
any type of protective helmet, and extreme care must be taken when removing the helmet.
. Surgical consultation for their evaluation and management is indicated
The finding of active arterial bleeding, an expanding hematoma, arterial bruit, or airway compromise
usually requires operative evaluation
Unexplained or isolated paralysis of an upper extremity should raise the suspicion of a cervical nerve
root injury and should be accurately documented.
45.
46.
47. Visual evaluation of the chest, both anterior and posterior, can identify
conditions such as open pneumothorax and large flail segments
palpation of the entire chest cage, including the clavicles, ribs, and sternum
Significant chest injury can manifest with pain, dyspnea, and hypoxia.
Evaluation includes inspection, palpation, auscultation and percussion, of the
chest and a chest x-ray
48. Identifying the specific injury is less important than determining whether
operative intervention is required.
A normal initial examination of the abdomen does not exclude a significant
intraabdominal injury
Early involvement of a surgeon is essential.
Pelvic fractures can be suspected by the identification of ecchymosis over the
iliac wings, pubis, labia, or scrotum.
Patients with a history of unexplained hypotension, neurologic injury, impaired
sensorium secondary to alcohol and/or other drugs, and equivocal abdominal
findings should be considered candidates for DPL, abdominal ultrasonography,
or, if hemodynamic findings are normal, CT of the abdomen
49. The perineum should be examined for contusions, hematomas, lacerations,
and urethral bleeding
A rectal examination may be performed to assess for the presence of blood
within the bowel lumen, integrity of the rectal wall, and quality of sphincter
tone.
Vaginal examination should be performed in patients who are at risk of vaginal
injury.
In addition, pregnancy tests should be performed on all females of childbearing
age.
50. The extremities should be inspected for contusions and deformities
Significant extremity injuries can exist without fractures being evident on
examination or x-rays.
Impaired sensation and/or loss of voluntary muscle contraction strength can be
caused by nerve injury or ischemia, including that due to compartment
syndrome.
The musculoskeletal examination is not complete without an examination of
the patient’s back.
51. includes motor and sensory evaluation of the extremities, as well as reevaluation of
the patient’s level of consciousness and pupillary size and response.
Early consultation with a neurosurgeon is required for patients with head injury to
decide whether conditions such as epidural and subdural hematomas require
evacuation, and whether depressed skull fractures need operative intervention.
If a patient with a head injury deteriorates neurologically, reassess oxygenation, the
adequacy of ventilation and perfusion of the brain (i.e., the ABCDEs)
Intracranial surgical intervention or measures for reducing intracranial pressure may
be necessary.
Thoracic and lumbar spine fractures and/or neurologic injuries must be considered
based on physical findings and mechanism of injury
Neurologic deficits should be documented when identified, even when transfer to
another facility or doctor for specialty care is necessary.
Protection of the spinal cord is required at all times until a spine injury is excluded.
Early consultation with a neurosurgeon or orthopedic surgeon is necessary if a spinal
injury is detected.
52. Specialized diagnostic tests may be performed .These include
additional x-ray examinations of the spine and extremities; CT scans of
the head, chest, abdomen, and spine; contrast urography and
angiography; transesophageal ultrasound; bronchoscopy;
esophagoscopy; and other diagnostic procedures
53. Trauma patients must be reevaluated constantly to ensure that new findings are not
overlooked and to discover any deterioration in previously noted findings.
A high index of suspicion facilitates early diagnosis and management
Continuous monitoring of vital signs, oxygen saturation, and urinary output is
essential. For adult patients, maintenance of urinary output at 0.5 mL/kg/h is
desirable. In pediatric patients who are older than 1 year, an output of 1 mL/kg/h is
typically adequate.
Periodic ABG analyses and end-tidal CO2 monitoring are useful in some patients.
The relief of severe pain is an important part of treatment for trauma patients
These agents are used judiciously and in small doses to achieve the desired level of
patient comfort and relief of anxiety while avoiding respiratory status or mental
depression, and hemodynamic changes
54. Whenever the patient’s treatment needs exceed the capability of the
receiving institution, transfer is considered. This decision requires a
detailed assessment of the patient’s injuries and knowledge of the
capabilities of the institution, including equipment, resources, and
personnel.
56. Meticulous record keeping is crucial during patient assessment and
management, including documenting the times of all events.
Accurate record keeping during resuscitation can be facilitated by assigning a
member of the trauma team the primary responsibility to accurately record
and collate all patient care information.
Medicolegal problems arise frequently, and precise records are helpful for all
individuals concerned.
Chronologic reporting with flow sheets helps the attending and consulting
doctors quickly assess changes in the patient’s condition
57. Consent is sought before treatment, if possible. In life-threatening
emergencies, it is often not possible to obtain such consent
In these cases, provide treatment first, and obtain formal consent later.
58. If criminal activity is suspected in conjunction with a patient’s injury, the
personnel caring for the patient must preserve the evidence.
Laboratory determinations of blood alcohol concentrations and other drugs
may be particularly pertinent and have substantial legal implications.
59. size and composition varies from institution to institution
includes a team leader, airway manager, trauma nurse, and trauma technician, as well as various residents and medical students
To perform effectively, each trauma team should have one member serving as the team leader, supervises, checks, and directs the
assessment; ideally he or she is not directly involved in the assessment itself.
the possible roles, depending on the size and composition of the team:
1. Assessing the patient, including airway assessment and management
2. Undressing and exposing the patient
3. Applying monitoring equipment
4. Obtaining intravenous access and drawing blood
5. Serving as scribe or recorder of resuscitationactivity
A useful acronym to manage this step is MIST:
• Mechanism (and time) of injury
• Injuries found and suspected
• Symptoms and Signs
• Treatment initiated
When the patient has left the ED, the team leader conducts an “After Action” session. In this session, the team addresses technical and
emotional aspects of the resuscitation and identifies opportunities for improvement of team performance