Initial Assessment and Management Trauma Patients
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This document outlines guidelines for trauma management and care. It describes conducting primary and secondary surveys to identify and treat life threats, institute monitoring, and anticipate complications. The primary survey focuses on airway, breathing, circulation, disability, and exposure to stabilize the patient. The secondary survey involves a full history and physical exam to diagnose all injuries through repeated evaluation. Key steps include protecting the spine, controlling hemorrhage, preventing hypothermia, and considering special populations. The guidelines emphasize a team approach and preparing for potential deterioration or pitfalls at each stage of care.
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This document provides guidance on trauma management. It discusses the golden hour concept and ABCDE approach for initial assessment and stabilization of trauma patients. It covers airway management techniques including endotracheal intubation and surgical airways. It also addresses breathing issues like tension pneumothorax and needle decompression. The document provides a comprehensive overview of trauma resuscitation from the pre-hospital phase to definitive care in the hospital.
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
This document provides guidelines for clearing the cervical spine in trauma patients. It discusses the Canadian C-Spine Rules and Nexus Low Risk Criteria clinical decision rules that can be used to determine if imaging is needed. It also provides algorithms outlining the imaging and precautions recommended based on factors like the patient's age, clinical exam findings, mechanism of injury, and ability to be assessed. The key points are that clinical decision rules can help determine if imaging is needed, and imaging and precautions depend on the results and presence of injuries or neurological abnormalities found.
Jeopardy: Principles of Emergency Medicine
The document contains questions and answers related to first aid topics like vital signs, bleeding and shock, CPR, and emergency scenarios. It includes questions ranging from $100 to $500 on topics such as normal vital signs, the components of CPR, types of bleeding and shock, and assessing and treating common injuries and illnesses like burns, hypothermia, and carbon monoxide poisoning. The document tests knowledge through a Jeopardy game-like format.
Role of us in pelvic pain final
The document discusses the role of ultrasound in evaluating pelvic pain. It describes how ultrasound can be used to visualize the uterus, cervix, vagina, ovaries and surrounding structures. Common causes of pelvic pain that can be identified with ultrasound include adenomyosis, degenerating fibroids, prolapsing fibroids, ovarian cysts, endometriosis, pelvic inflammatory disease, ectopic pregnancy and others. The document provides detailed ultrasound images and descriptions of normal anatomy and various pathological conditions. It emphasizes that most adnexal cysts are benign even in postmenopausal women and outlines a roadmap for managing ovarian cysts identified on ultrasound.
AC Joint Separation
A 42-year-old man presented to the emergency department after being struck in the right shoulder with a baseball bat. On exam, he refused to move his shoulder due to pain and tenderness over the top of the shoulder. Imaging showed widening of the acromioclavicular joint space, indicating an AC joint separation. The separation was likely a Type III injury, with a complete tear of the AC and coracoclavicular ligaments and separation of the AC joint, requiring internal fixation surgery to repair the injury.
Lesson 11
The patient has shallow breathing, cyanosis, bruising on the chest, and decreased breath sounds on the left side. The GCS score is 7 and oxygen should be delivered to maintain an SpO2 over 95%. Direct pressure controls bleeding from the right arm but the patient has a weak, rapid pulse of 140. There is pelvic crepitus and tenderness and a deformed left thigh, indicating shock. Basic shock therapy like warming and splinting should be provided, including consideration of a PASG. Spinal immobilization and rapid transport within 10 minutes are indicated.
Approach to problem fractures
This document discusses fractures that require special attention due to their location or potential to be overlooked. It identifies two main groups - fractures of the ribs, scapula, Lisfranc joint, cervicothoracic junction, and posterior spinal elements, and fractures of the scaphoid, radial head, and femoral neck. It emphasizes the importance of optimal imaging like CT scans to detect these fractures, and provides guidance on imaging techniques and views needed to properly evaluate common fracture sites.
Missed fractures in Emergency Department
This document discusses reasons why fractures may be missed when interpreting radiographs. It lists 8 common reasons, including failure to take a thorough history or examine the patient, failure to view all films carefully, and failure to order additional views when needed. It then provides examples of specific fractures and injuries that could be missed in the wrist, elbow, hip, knee, and foot if not carefully evaluated. Key fractures discussed include scapholunate dissociation, perilunate dislocation, Monteggia fractures, and calcaneus fractures.
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initial assessment and primary management in trauma
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Day 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
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Initial Assessment and Management Trauma Patients
- 2. Dr George Mukhari Academic Hospital Department of Surgery Trauma Unit University of Limpopo
- 3. Apply principles of primary and secondary surveys Identify management priorities Institute appropriate resuscitation and monitoring History and biomechanics of injury Anticipate pitfalls
- 6. Gown Gloves Mask Shoe Covers Goggles / face shield
- 7. Sorting of patients according to ABCDEs Available resources
- 8. Identify yourself Ask the patient his / her name Ask the patient what happened
- 9. A Patent airway C D Clear sensorium B Sufficient air reserve to permit speech If no response, proceed with rapid primary survey
- 10. A Airway with c-spine protection B Breathing C Circulation with hemorrhage control D Disability E Exposure / Environment
- 11. Trauma in the elderly Pediatric trauma Trauma in pregnant women
- 12. Establish patent airway Protect c-spine Pitfalls? Equipment failure Inability to intubate Occult airway injury Progressive loss of airway
- 13. Level of consciousness Skin color and temperature Pulse rate and character
- 14. Control hemorrhage Restore volume Reassess parameters Special care Elderly Children Athletes Medications
- 15. Disability Basic neurologic evaluation GCS scoring Pupillary response
- 16. Completely undress the patient
- 17. Protect and secure airway Ventilate and oxygenate Stop the bleeding! Prevent hypothermia
- 18. ADJUNCTS Vital signs ABGs Pulse oximeter and capnograph Urinary / gastric catheters unless contraindicated Urinary output ECG
- 19. DPL FAST Diagnostic Tools
- 20. Complete Examination of patient
- 21. Primary survey is completed ABCDEs are reassessed Vital functions are returning to normal After
- 22. History Physical exam: Head-to-toe PR + PV Complete neurologic exam Special diagnostic tests Reevaluation
- 23. A M P L E History Allergies Medications Past illnesses Last meal Events / Environment
- 24. MVA Blunt + sharp assault Fall Burns
- 25. GCS Score Neurologic exam Comprehensive eye and ear exam Head
- 26. Bony crepitus Deformity Malocclusion Potential airway obstruction Maxillofacial
- 27. Tenderness Complete motor / sensory exams Reflexes Imaging studies ↓ GCS Cervical Spine Pitfalls?
- 28. Mechanism: Blunt vs penetrating Symptoms: Airway obstruction, hoarseness Findings: Crepitus, hematoma, stridor, bruit Neck (soft tissues)
- 29. Inspect Palpate Percuss Auscultate Obtain x-rays Chest
- 30. Inspect Auscultate Palpate Percuss Reevaluate Special studies Abdomen
- 31. Hollow viscus injury Retroperitoneal injury Excessive pelvic manipulation Abdomen: Pitfalls?
- 32. Secondary Survey Rectum Sphincter tone, high- riding prostate, pelvic fracture, rectal wall integrity >> Blood / Lacerations Vagina Contusions, hematomas, lacerations, urethral blood Examine Perineum
- 33. Contusion, deformity Pain Perfusion Peripheral neurovascular status X-rays as needed Musculoskeletal: Extremities
- 34. Pain on palpation Symphysis width Leg length unequal Instability X-rays as needed Musculoskeletal: Pelvis
- 35. Potential blood loss Missed fractures Soft-tissue or ligamentous injury Compartment syndrome (especially with altered sensorium / hypotension) Musculoskeletal: Pitfalls
- 36. GCS Score Lateralizing signs Frequent reevaluation Prevent secondary brain injury Neurologic: Brain Refer Neurosurgeon
- 37. Complete motor and sensory exams Imaging as indicated( CT, MRI ) Reflexes Neurologic: Spine and Cord
- 38. Secondary Survey Neurologic: Pitfalls Incomplete immobilization Subtle in ICP with manipulation Rapid deterioration
- 39. Special diagnostic tests as indicated Pitfalls? Patient deterioration Delay of transfer
- 40. High index of suspicion Frequent reevaluation and monitoring
- 41. Relief of pain / anxiety as appropriate Administer intravenously Careful monitoring is essential
- 42. Those whose injuries exceed institutional capabilities Examples Multisystem or complex injuries Patients with comorbidity or age extremes
- 43. As soon as possible after stabilizing measures are completed Airway and ventilatory control Hemorrhage control (operation)
- 44. Concise, chronologic documentation Consent for treatment Forensic evidence
- 45. QUESTIONS