Initial trauma ppt yeaaaaajjsjskdkdkdkdd

1. INITIAL ASSESSMENT OF TRAUMA PATIENT MOHAMED ALASMAR

2. OBJECTIVES Initial Assessment of Trauma Patient What, Why and How ABCDE

3. INITIAL ASSESSMENT Step One Preparation Primary Survey (Resuscitation and Adjuncts) Re-evaluation Step two Detailed Secondary Survey Re-evaluation Adjuncts Step Three Re-evaluation Definitive care / Transfer Tertiary Survey

4. PREPARATIO N Trauma call PPE Assign roles / team Mobilize resources Check equipment / Medications Proper Handover

5. CASE PRESENTATIO N • Mechanism of injury M • Injuries suspected I • Symptoms S • Treatment T

6. WHAT IS THE SEQUENCE OF PRIORITIES ? • Airway A • Breathing B • Circulation C • Disability D • Exposure / Environment E

7. WHY ABCDE?

8. HOW TO DO ABCDE? A • Is the airway patent and clear? • Is there a need for a definitive airway? • Is there a suspicion of spine injury? B • Are there any immediate life- threatening injuries? • before doing the chest X-ray, did I manage the immediate life- threatening injuries? • What is the SO2? and X-ray finding? C • Is the patient shocked? • Which type of shock? • Where is the bleeding? D • Is there a Traumatic Brain Injury? • What will I do for the 1ry insult? • What will I do to prevent the 2ry insult? E • Is there any other injuries? • Am I preventing the hypothermia? • Am I considering my adjuncts and re-evaluation of the patient?

9. INITIAL ASSESSMENT Step One Preparation Primary Survey (Resuscitation and Adjuncts) Re-evaluation Step two Detailed Secondary Survey Re-evaluation Adjuncts Step Three Re-evaluation Definitive care / Transfer Tertiary Survey

10. SUMMARY Initial Assessment of Trauma Patient What, Why and How ABCDE

12. OBJECTIVES Assessment of Airway Management of Airway What is definitive airway When to use definitive airway

14. ASSESSMENT OF AIRWAY Speak to the patient Speak Look for evidence if facial trauma or burn Look Listen for noisy airway or no airway sounds Listen

15. INITIAL MANAGEMENT OF AIRWAY O2 VIA TIGHT-FITTING OXYGEN MASK PULSE OXIMETER ECG BLOOD PRESSURE CUFF

16. MANAGEMENT OF COMPROMISE D AIRWAY Jaw thrust / No Neck tilt Suction Bag-Mask ventilation Nasopharyngeal / oropharyngeal airway Extraglottic or Supraglottic airway / LMA Definitive Airway

17. INDICATIONS OF DEFINITIVE AIRWAY • Inability to maintain airway • Impending or potential airway compromise • Threatened airway / Vomiting / Blood / Facial injury A • In ability to maintain oxygenation by facemask • Apnoea • Flail segment / Lung contusions B • Sever terminal shock • Combative patients from hypoperfusion C • Obtundation / Head injury / GCS 8 or less • Seizures D • Anticipate deterioration of any of the above • Consider Combination of any of the above E

18. DIFFICULT AIRWAY  Surgical Airway  Cannot intubate  Cannot ventilate

20. SUMMARY Assessment of Airway Management of Airway What is definitive airway When to use definitive airway

22. OBJECTIVES Assessment of breathing Immediate life-threatening injuries Management of immediate life- threatening injuries Potential life-threatening injuries

24. IMPORTANCE OF “B”  Airway and breathing problems are interlinked  Causes of shock in the chest  Tension pneumothorax  Massive haemothorax  Cardiac tamponade  These injuries can compound the effects of shock due to other haemorrhagic and non-haemorrhagic injuries.

25. ASSESSMENT Ensure adequacy of the airway Ensure Look for evidence of respiratory distress •Tachypnoea •Use of accessory muscles of respiration •Look for abnormal/asymmetrical chest wall movement •Distension of neck veins •Cyanosis (late finding) Look Feel chest and neck •Hyper-resonance on percussion •Dullness to percussion •Subcutaneous air or pain and fractures •Position of trachea Feel Listen for signs of partial airway obstruction or compromise •Asymmetrical, reduced or absent breath sounds •Additional sounds (stridor) Listen

26. ASSESSMENT / ADNUNCTS Perform ECG Pulse oximetry End tidal capnography CXR/CT FAST Arterial blood gases

27. IMMEDIATE LIFE- THREATENING INJURIES HUNT FOR IMMEDIATE LIFE-THREATENING INJURIES BEFORE THEY HUNT YOU

28. IMMEDIATE LIFE- THREATENIN G INJURIES • Airway obstruction (laryngotracheal injury) • Tracheobronchial tree injury Airway • Tension pneumothorax • Open pneumothorax Breathing • Massive haemothorax • Cardiac tamponade • Traumatic Circulatory Arrest Circulatio

29. POTENTIAL LIFE- THREATENIN G INJURIES • Simple pneumothorax • Haemothorax • Flail chest • Pulmonary contusion • Blunt cardiac injury • Traumatic aortic disruption • Traumatic diaphragmatic injury • Blunt oesophageal rupture

30. FINGER THORACOSTOMY TRAUMA-ROOM THORACOTOMY

32. SUMMERY Assessment of breathing Immediate life-threatening injuries Management of immediate life- threatening injuries Potential life-threatening injuries

33. INITIAL ASSESSMENT OF TRAUMA PATIENT MOHAMED ALASMAR Circulation

34. OBJECTIVES What is shock? Diagnosis of shock Management of shock

36. HOW TO DO ABCDE? Definitive airway A Immediate life- threatening injuries B Shock C Traumatic brain injury D Extra E

37. WHAT IS SHOCK? Cardiogenic Distributive Hypovolemic Obstructive

38. HOW TO DIAGNOSE SHOCK? Neuroendocrinal response Tachycardia Pallor Sweaty Cold Thirsty Hypoxia / Hypoperfusion Tachypnoea Anxiety then Disturbed conscious level Urine output Prolonged capillary refill Low volume Narrow pulse pressure Low blood pressure

39. PITFALLS IN DIAGNOSIS Blood Pressure 01 Conscious level 02 Hemoglobin level 03 Type of shock 04 Shock due to brain injury 05

41. BLOOD IN THE FLOOR AND 4 MORE Chest Abdomen Pelvis Long bone

42. MANAGEMENT OF HAEMORRHAGIC SHOCK STOP REPLACE

43. PITFALLS IN C Blood Pressure 01 Conscious level 02 Hemoglobin level 03 Type of shock 04 Shock due to brain injury 05 Replacing without stopping 06

44. BLOOD IN THE FLOOR AND 4 MORE Chest Abdomen Pelvis Long bone Stop The Bleeding Manage other types of shock accordingly

45. SUMMERY What is shock? Diagnosis of shock Management of shock

46. INITIAL ASSESSMENT OF TRAUMA PATIENT MOHAMED ALASMAR Disability

47. OBJECTIVES Assessment Management

49. HOW TO DO ABCDE? Definitive airway A Immediate life- threatening injuries B Shock C Traumatic brain injury D Extra E

50. ASSESSMENT GCS Pupils Lateralizing sign

51. GCS

53. DISTURBED CONSCIOU S LEVEL Do not assume it is related to alcohol Do not assume it is due to haemorragic shock Hemorrhage is the most common case of shock in trauma patient

54. Neurogenic shock Spinal shock

55. MANAGEMENT • Neurosurgical input • Transfer Primary Brain insult • Prevent Hypoxia and hypo and hypercarbia • Prevent Hypotension Secondary Brain insult

57. INITIAL ASSESSMENT OF TRAUMA PATIENT MOHAMED ALASMAR ROCSM

58. RESTRICTION OF CERVICAL SPINE MOTION

59. OBJECTIVES When to ROCSM? How to ROCSM? Why ROCSM? When to clear the spine?

60. WHEN DO WE NEED TO ROCSM Suspect Protect Detect

61. HOW TO ROCSM? Collar + protection of the whole spine with long spine board

62. CLEAR THE SPINE Radiographic imaging may need to be used to exclude spinal injury – usually CT scan. It is possible to ‘clinically clear’ the spine in a conscious and fully orientated and alert patient only. Efforts should be made to ‘clear’ the spine as expeditiously as possible to prevent damage to soft tissues from the board or collar.

63. WHEN TO CLEAR THE SPINE?

64. CANADIAN C SPINE RULES

66. OBJECTIVES When to ROCSM? How to ROCSM? Why ROCSM? When to clear the spine?

67. THANK YOU

Initial trauma ppt yeaaaaajjsjskdkdkdkdd

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