5. INTRODUCTION
A multiply-injured patient is a patient that has
sustained significant injury in 2 or more systems or
organs within the same system.
A critically injured patient is one that has sustained a
life threatening trauma.
6. EPIDEMIOLOGY
TRAUMA:
- Leading cause of death in pxs < 45 yrs.
- Responsible for 60% of deaths in 15-24 yr old
- 3rd leading cause of death in all ages
IMPACT OF TRAUMA:
- Significant loss of work force productivity
- Cost of care/rehabilitation
- Psychological & emotional stress
7. EPIDEMIOLOGY
TRIMODAL PATTERN OF MORTALITY:
The first peak (immediate deaths)
- Constitute 50% of the mortality
- Occur within minutes of injury
- Are related to laceration of the brain,
brainstem, spinal cord, heart & great vessels.
The second peak (early deaths)
- Constitute 30% of the mortality
- Occur within the first few hours after injury
- Causes include major internal haemorrhages
in the CNS, thorax & abdomen.
8. TRIMODAL PATTERN OF MORTALITY
The third peak (late deaths)
- Constitute 20% of the mortality
- Occur within days or weeks after injury
- Due to infection & MOF.
9. AETIOLOGY
- Road traffic accident
- Industral accident
- Domestic accident
- Fall from height
- Sport injuries
- Social violence and conflict
- Airplane & train crashes
- Natural disasters
- Warfare injuries/Terrorism
10. LEVELS OF CARE
PRE-HOSPITAL PHASE: COMMUNITY BASED
- Essentially involves the supply of trained ambulance crews, in
particular paramedics to carry out BTLS services.
HOSPITAL PHASE:
* Based on ATLS protocol;
- Primary survey/Resuscitation
- Secondary survey
- Definitive care phase
11. ABCDE OF RESUSCITATION
- A-airway
- B-breathing
- C-circulation
Properly position the patient in a left lateral position
12. RESUSCITATION CONTD
A - Airway and cervical spine control:
If the airway is not patent:
- remove foreign bodies/dislodged teeth
- use suction for blood/vomitus
- chin lift/jaw thrust without moving the head
- consider oropharyngeal airway.
If no improvement - attempt endotracheal
intubation.
If not possible - needle/surgical cricothyroidotomy.
Apply ‘in-line’ immobilisation of the cervical spine
until a rigid collar is available
13. RESUSCITATION CONTD
B - breathing and ventilation:
- Look for chest wall movement.
- Feel for tracheal position.
- Listen on Percussion and auscultation of the chest.
Identify and treat open or tension pneumothorax.
Identify flail chest and massive haemothorax.
14. RESUSCITATION CONTD
C - circulation and control of haemorrhage :
Pulse quality, skin perfusion and neck vein distension
are assessed.
Two widebore cannulae (size 16G) are inserted for
IVF.
Blood sample is taken for urgent cross-matching,
biochemistry and haematology.
Control external haemorrhage
15. RESUSCITATION CONTD
D - Disability (neurological assessment):
Assess conscious level:
→ A - alert (GCS 14 &15)
→ V - responds to voice ( GCS 12)
→ P - responds to painful stimulus
→ U - unresponsive. (GCS 8 & <)
A Glasgow Coma Scale (GCS) assessment is performed
on subsequent reassessment of the px.
16. RESUSCITATION CONTD
E – exposure:
The patient is fully undressed in a warm environment
to avoid hypothermia
• Monitoring is established with
Pulse rate
pulse oximeter ,
urine output
frequent B/P monitoring
17. EVACUATION
- Stabilise fractures
- Ensure the safe transfer of the patient to
appropriate hospital
- Alert the appropriate specialists or activate
the Trauma Team prior to arrival.
“Scoop and run” or “stay and play”
approach may be adopted depending on the
prevailing circumstances.
18. SECONDARY SURVEY
DETAIL HISTORY
Events leading to trauma
Mechanism of injury
Venue of injury
Time of injury
Position of patient
Patient restraint or not
Morbidity and Mortality
What kind of first aid
patient has received
already
tions curren Events /
Environment related to injury
2/24/15 NTBLC CME 20
19. HISTORY CONTD
History suggestive of major trauma include:
- RTA with MV collision
- Severely damaged vehicle front or side
- Patient ejection
- Death of co-occupant
- Roll over of vehicle
- Fall from ht >6M (children >3M)
2/24/15 21
NTBLC CME
20. Physical examination
Detailed head-to-toe examination
Head & Neck;
Chest;
Abdomen
Perineum
- A rectal examination is also carried out to assess anal tone,
rectal bleeding, and possible urethral injury.
- Musculoskeletal exam
22. THE CARE OF A MULTIPLY INJURED
Passage of Nasogastric tube
Analgesia
Antibiotic prophylaxis
Urethral catheterization (output chart)
Tetanus prophylaxis:
- Wounds which are tetanus-prone include those which are
heavily contaminated with soil or faeces, have a delayed
presentation for wound debridement, have extensive tissue
damage, or are puncture wounds.
2/24/15 24
NTBLC CME
23. INVESTIGATIONS
FBC & Diff
U & E
Abdominal USS
Diagnostic peritoneal lavage
X-ray-AP & Lateral
Abdominal CT scan
MRI
25. CONCLUSION
Multiple injury is a major trauma
Adequate & aggressive initial resuscitation enhance
survival of the patient
Approach to management is multidisplinary
Prevention of injury is always beneficial not only to
the individual but also the community at large.
