1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. Symptoms can range from minimal signs to cardiovascular collapse.
2) The spleen, liver, and kidneys are most commonly injured in blunt trauma due to their solid nature. Injuries to hollow organs like the stomach and intestines also occur from shearing forces.
3) Initial assessment focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Patients are fully evaluated and stabilized, with two IV lines placed and fluid resuscitation started if indicated. Ongoing monitoring of vitals and input/output is important
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Content will be helpful for B.Sc. and M.Sc. nursing students as it describes causes, signs and symptoms, diagnosis,emergency mangement , medical and nursing management.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Content will be helpful for B.Sc. and M.Sc. nursing students as it describes causes, signs and symptoms, diagnosis,emergency mangement , medical and nursing management.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. INTRODUCTION
• Abdominal trauma is an injury to the abdomen.
• Abdominal trauma is divided into:
Penetrating abdominal trauma (PAT), usually
diagnosed based on clinical signs.
Blunt abdominal trauma is more likely to be
delayed or altogether missed because clinical
signs are less obvious.
Blunt injuries predominate in rural areas, while
penetrating ones are more frequent in urban
settings.
3. EPIDEMIOLOGY
• Motor vehicle accidents are responsible for
75% of all blunt trauma abdominal injuries
• More common in elderly due to less resilience.
• Blunt injuries causes solid organ trauma
(spleen, liver and kidneys) more often than
hollow viscera.
• Multi organ injury and multiple system injury
are also more common in blunt injury than in
other types.
4. MECHANISMS OF INJURY
• CRUSHING: Direct application of a blunt force to the
abdomen
• SHEARING: Sudden decelerations apply a shearing
force across organs with fixed attachments.
• BURSTING: Raised intraluminal pressure by
abdominal compression accurately in hollow organs
can lead to rupture
• PENETRATION: Disruption of bony areas by blunt
trauma may generate bony spicules that can cause
secondary penetrating injury
13. PRESENTATION
• Varies widely from hemodynamic stability with minimal
abdominal signs to complete cardiovascular collapse and
may change from one to the other with alarming rapidity.
• Injuries are often categorized by type of structure that is
damaged:
a) Abdominal wall
b) Solid organ (liver, spleen, pancreas, kidneys)
c) Hollow viscus (stomach, small intestine, colon,
ureters, bladder)
d) Vasculature
14. • Spleen is the most common cause of massive bleeding in
blunt abdominal trauma to a solid organ. Spleen is the
most commonly injured organ. The spleen is the second
most commonly injured intra-abdominal organ in children.
A laceration of the spleen may be associated with
hematoma. Because of the spleen's ability to bleed
profusely, a ruptured spleen can be life-threatening,
resulting in shock.
15.
16. ORGAN INJURIES
SOLID ORGANS
• Solid organs most commonly injured in blunt traumas
• In decreasing incidence of injury
i. Spleen
ii. Liver
iii. Kidneys
iv. Intraperitoneal small bowel
v. Bladder
vi. Colon
vii. Diaphragm
viii. Pancreas and duodenum
17. HOLLOW VISCERA
• Duodenum commonly injured
• Small bowel injured at relatively fixed areas
(duodenojejunal flexure and ileocaecal junction)
by shearing force
• Colon relatively protected.
→Gaseous distension of caecum – most
vulnerable part as fixed.
• Stomach rarely injured – compression cause
esophagogastric junction bursting
18. RETROPERITONEUM AND UROGENITAL
TRACT
• Kidney injury - common next to spleen and liver
• Pancreatic injury - 4% cases of trauma
• Bladder - most commonly injured extra-
peritoneally by shearing at the vesico-urethral
junction.
→intraperitoneally by blunt force on distended
bladder
• Rupture of prostatic urethra by shear forces is
commonly seen with hemorrhage
19. INITIALASSESSMENT
• Determine if the patient is hemodynamically stable.
• Use a systematic approach based on ABCDE to assess
and treat an acutely injured patient. Unless there are
associated injuries, most patients with abdominal trauma
generally present with a patent airway. Alterations found in
breathing, circulation and disability assessments generally
correspond to the degree of shock. The goal is to manage
any immediate threats to life and identify any emergent
concerns that may require activation of retrieval services
and early transfer.
•
20. PRIMARY SURVEY: AIRWAY
Assess for airway stability
• Attempt to elicit a response from the patient.
• Look for signs of airway obstruction (use of accessory
muscles, paradoxical chest movements, see-saw
respirations).
• Listen for any upper-airway noises, breath sounds. Are
they absent, diminished or noisy? Noisy ventilations
indicate a partial airway obstruction by either the tongue
or foreign material.
Assess for soiled airway
• Hemorrhage and vomiting are common causes of airway
obstruction in trauma patients. These should be removed
with suction.
21. PRIMARY SURVEY: AIRWAY
Attempt simple airway maneuvers if required
• Open the airway using a chin lift and jaw thrust.
• Suction the airway if excessive secretions are noted or if
the patient is unable to clear their airway independently.
• Insert an oropharyngeal airway (OPA) if required.
• If the airway is obstructed, simple airway-opening
maneuvers should be performed as described above.
Care should be taken to not extend the cervical spine.
Caution: NPA should not be inserted in patients with a
head injury in whom a base of skull fracture has not been
excluded.
22. PRIMARY SURVEY: AIRWAY
Secure the airway if necessary (treat airway obstruction as a
medical emergency)
• Consider intubation early if there are any signs of:A decreased
level of consciousness GCS <9, unprotected airway,
uncooperative/combative patient leading to distress and further
risk of injury
• Hypoventilation, hypoxia or a pending airway obstruction:
stridor, hoarse voice.
• Assist ventilation with a bag and mask while the provider is
setting up for intubation.
Maintain full spinal precautions if indicated
• Suspect spinal injuries in polytrauma patients, especially where
there is an altered level of consciousness. Ensure cervical
collar, head blocks or in-line immobilisation is maintained
throughout patient care.
23. PRIMARY SURVEY: BREATHING
• Patients with early, compensated shock may have a mild
increase in their respiratory rate, however those with more
severe hypovolemic shock will display marked tachypnea.
Assess the chest
• Count the patient’s respiration rate and note the depth
and adequacy of their breathing. Auscultate the chest for
breath sounds and assess for any wheeze, stridor or
decreased air entry. Be mindful that in the setting of
abdominal trauma, potential thoracic injuries may have
occurred also. Rupture of the hemi diaphragm often leads
to compromise of respiratory function and bowel sounds
may be heard over the thorax when breath sounds are
auscultated.
24. PRIMARY SURVEY: BREATHING
Record the oxygen saturation (SpO2)
• Adequate oxygenation to the brain is an essential element
in avoiding secondary brain injury. Monitor the SpO2 and
maintain it above 95%. Failure to keep saturations above
this rate is associated with poorer outcomes.
Ensure high-flow oxygen is administered to maintain
saturations above 95%.
26. PRIMARY SURVEY: CIRCULATION
• Shock from intra-abdominal haemorrhage may range from
mild tachycardia with few other findings to severe
tachycardia, marked hypotension and pale, cool, clammy
skin. The most reliable indicator of intra-abdominal
haemorrhage is the presence of hypovolemic shock from
an unexplained source.
In immediate trauma care aim for a blood pressure
greater than 90 mmHg systolic or a shock index less than
1 (HR/SBP).
Insert x 2 large bore peripheral IV cannulas. If access
is difficult, consider a central or intraosseous
insertion if the equipment / skills are available.
27. PRIMARY SURVEY: CIRCULATION
Commence fluid resuscitation as indicated
• Initial treatment of hypovolemia with crystalloid fluids
(normal saline) is recommended, up to 20–30 mL/kg.
Blood pressure goals for penetrating trauma or
uncontrollable hemorrhage are generally lower than for
blunt trauma in the absence of a major head injury. (SBP
values less than 90 mmHg may be acceptable if cerebral
perfusion is maintained – that is, if conscious state is
normal). Early consultation about such patients is
required.
28. PRIMARY SURVEY: DISABILITY
• Assess level of consciousness
• Perform an initial Glasgow Coma Scale (best eye
opening, motor response and verbalisation).
• Check pupil size and reactivity if conscious state
is altered.
• Test blood sugar levels
• Ensure that any alterations in level of
consciousness are not related to a metabolic
cause.
29. PRIMARY SURVEY: EXPOSURE
• By the end of the primary survey the patient should have been
fully exposed so as to ensure no injuries posing an immediate
life threat are missed.
• Consideration must be given to the patient’s age, gender and
culture when exposing them for a trauma examination.
• Exposure may need to be done sequentially, uncovering one
body region at a time to maintain patient dignity.
• Trauma patients are prone to hypothermia, so upon completion
of the primary survey, they should be covered with dry, warm
blankets.
• External warming devices may be required if the patient is even
mildly hypothermic. All intravenous fluid or blood should be
warmed prior to administration if a fluid warmer is available.
30. SECOND PRIORITIES
HISTORY
• To know injury mechanism (mode of injury) – to anticipate
injury patterns and raise the index of suspicion for occult
injury.
• Events preceding the injury
• General principles :
Serial examinations by the same examiner improves
sensitivity
Spinal cord injury masks clinical findings
Tenderness blunted by intoxicants
31. PHYSICAL EXAMINATION
General Examination : relating to hemodynamic
stability Abdominal findings :
Inspection
for abdominal distension
for contusions or abrasions
lap belt ecchymosis – mesenteric, bowel, and
lumbar spine injuries
periumblical (Cullen sign) and flank (Grey Turner
Sign) ecchymosis – retroperitoneal haematoma
32. • The classical ‘seatbelt’
sign. The bruising on
the left breast is from
the shoulder belt and
the low bruising to the
abdominal wall is from
the lapbelt.
33.
34. Palpation
• for tenderness, guarding and/or rigidity, rebound
tenderness – hemoperitoneum
Percussion
• Dullness/ shifting dullness – intrabdominal collection
Auscultation
• Presence or absence of bowel sounds
35. Rectal findings
• Check for gross blood - pelvic fracture
• Determine prostate position – high riding prostate –
urethral injury
• Assess sphincter tone – neurologic status
Distal pulses
• Assess for absence or asymmetry
• Assessment of other associated injuries i.e. multiple
fractures, spinal injuries etc.
36. DIAGNOSTIC STRATEGY
•To identify those with injuries
•To decide which ones need
laparatomies
•To determine how fast this should be
done
37. • Base line investigations
• Four quadrant tap
• Diagnostic peritoneal lavage (DPL)
• Ultrasound – FAST (focused assessment
with sonography for trauma)
• Abdominal CT scan
• Diagnostic laparoscopy
• Laparotomy
38.
39. BASELINE INVESTIGATIONS
• Hemogram with hematocrit
• ABG
• Electrocardiogram
• Renal function tests
• Urine analysis – +nce of hematuria – genito urinary injury
• -nce of hematuria – does not rule out it
Serum amylase / lipase or liver enzymes - increase -
suspicion of intraabdominal injuries
41. ABDOMINAL: RADIOGRAPHS
• Pneumoperitoneum – perforation of hollow viscus
• Ground glass appearance – massive
hemoperitoneum
• Dilated gut loops- retroperitoneal hematoma or
injury
• Retroperitoneal air outlining the right kidney –
duodenal injury
• Double wall sign – air inside and outside the
bowel
• Distortion or enlargement of outlines of viscera –
hematoma in relation to respective organs
43. INDICATIONS FOR FURTHER TESTING
• Unexplained hemorrhagic shock
• Major chest or pelvic injuries
• Abdominal tenderness
• Diminished pain response due to:
Intoxication
Depressed level of consciousness
Distracting pain
Paralysis
• Inability to perform serial examination
44. FOUR QUADRANT TAP
• Overall accuracy – about 90%
• Positive tap – obtaining 0.1 ml or more of non clotting
blood Negative tap does not rule out hemorrhage
DIAGNOSTIC PERITONEAL LAVAGE
Criteria for positive tap
Gross bloody tap
>1,00,000 RBCs per mm
500 white blood cells per mm
Elevated amylase level
Presence of bile or bacteria or feces
45.
46. ULTRASOUND; FAST EXAMINATIONS ( focused assessment
with sonography for trauma ).
Advantages
• Inexpensive, noninvasive and portable
• Performed by emergency physicians and surgeons trained in
performing FAST examinations.
• Avoids risks associated with contrast media
• Confirms presence of hemoperitoneum in minutes
a) Deceases time to laparotomy
b) Great adjunct during multiple casualty disasters
• Serial examination can detect ongoing hemorrhage
Differentiates pulseless electrical activity from extreme
hypotension
• With pregnant trauma patients, determines gestational age and
fetal viability
47. Disadvantages
• A minimum of 70 ml of intraperitoneal fluid for positive
study.
• Accuracy is dependent on operator / interpreter skill and
is decreased with prior abdominal surgery.
• Technically difficult with – obese, ileus or subcutaneous
emphysema is present
• Does not define exact cause of hemoperitoneum
• Sensitivity is low for small-bowel and pancreatic injury
Sensitivity – 69%-99%
Specificity – 86%-98%
48. Technique
Four basic transducer positions used to find
abdominal fluid.
Subxiphoied – hemopericardium
Right upper abdominal quadrant - fluid in
Morrison’s pouch
Left upper abdominal quardant –fluid in
perisplenic space
Suprapubic – fluid in Douglas pouch
49.
50. ABDOMINAL CT SCAN
• Latest generation of helical and multislice
scanners provides rapid and accurate
diagnostic information.
• Criterion standard for solid organ injuries.
• Help quantitate the amount of blood in the
abdomen and can reveal individual organs
with precision.
51.
52.
53. LAPAROSCOPY
Advantages
• The extent of organ injuries and determines the need for
laparotomy
• Defines which intraabdominal injuries may be safely
managed non-surgically
• More sensitive than DPL or CT in uncovering
a)Diaphragmatic injuries
b)Hollow viscus injuries
• Surgery can be done in same sitting
a)With laparoscope with minimal trauma
b)Open surgery
• Sampling for HPR can be taken
54. Disadvantages
• Pneumoperitoneum may elevate ICP
• General anesthesia usually necessary
• Patient must be hemodynamically stable
Complications
• Bleeding or injury
• Gas embolism and pneumoperitoneum
55. LAPAROTOMY
INDICATIONS
Absolute criteria
• Peritonitis (gross blood, bile or feces)
• Pneumoperitoneum or pneumoretroperitoneum
• Evidence of diaphragmatic defect
• Gross blood from stomach or rectum
• Abdominal distension with hypotension
• Positive diagnostic test for an injury requiring operative
repair
56.
57. NON OPERATIVE INJURY
MANAGEMENT
General considerations
criteria for non operative management
• Patient hemodynamically stable after initial
resuscitation
• Continuous patient monitoring for 48 hrs
• Surgical team immediately available
• Adequate ICU support and transfusion services
available
• Absence of peritonitis
• Normal sensorium
58. •Angioembolization may be alternative
to surgical intervention
•All patients with solid organ injury
managed non-operatively require
admission for observation, serial
hematocrit measurement, and repeat
imaging