Polytrauma approach in emergency

1. Approach to Polytrauma
Patient
Dr.Vemula Sathyanarayana
MD Emergency medicine
Senior resident
GIMSR

3. Introduction
• Approximately 12,000 deaths world wide each day.
• 4.4 Million trauma related deaths/year.
• 1 in 3 RTA related deaths
• 1 in 6 Suicide related deaths
• 1 in 9 from Homicide

4. In India
• 400 trauma related deaths per day
• 1 Million Trauma related deaths per year
• RTA is the leading cause of death

6. • Linear or longitudinal, progression of events
• Horizontal resuscitation

7. • Preparation
• Triage
• Primary survey(ABCDEs) with immediate resuscitation of patients with life-
threatening injuries
• Adjuncts to the primary survey and resuscitation
• Consideration of the need for patient transfer
• Secondary survey(head-to-toe evaluation and patient history)
• Adjuncts to the secondary survey
• Continued post resuscitation monitoring and reevaluation
• Definitive care

8. Preparation
• Prehospital phase
• ABC
• Immobilization
• Minimise scene time
• Field Triage

12. Handover
• M
• I
• S
• T

13. • Hospital phase
• Briefing
• PPE
• Equipment

15. • In hospital Triage
• Multiple casualties
• Mass casualties

16. Primary survey with simultaneous
resuscitation
• Always
A
B
C
D
E
• 10 seconds

18. • Breathing and ventilation

19. Circulation with hemorrhage control
• Blood volume and Cardiac output
• Level of Consciousness
• Skin perfusion
• Pulse
• Bleeding – Floor and four more

20. • Disability (Neurological evaluation)
• GCS
• Pupils
• Capillary Blood Glucose

21. • Primary brain injury
• Secondary brain injury

22. • Exposure and Environment control
• Completely undress the patient
• Prevent hypothermia
• Lethal triad

24. Adjuncts to the primary survey with
resuscitation
• 2 catheters
• 2 “G” s
• 2 X-Rays
• Do it FAST

27. • Pulse oximetry
• Ventilatory rate and Capnography

29. • Consider need for patient transfer
• Special populations
• Children
• Pregnant women
• Older adults
• Obese patients
• Athletes

30. Secondary survey
• History
• A
• M
• P
• L
• E
• Mechanism of injury

33. • Physical examination
• Head
• Maxillo facial structures
• Cervical Spine and Neck
• Chest

34. • Abdomen and Pelvis
• Perineum, Rectum and Vagina
• Musculoskeletal System
• Neurological System

35. • Adjuncts to the secondary survey
• Re-evaluation
• Definitive care
• Records

36. • Consent for treatment
• Forensic evidence
• Teamwork