Polytrauma, or multisystem trauma, refers to injuries that affect multiple body systems and require a team-based approach to management. It is a leading cause of death among younger individuals. The document outlines the definition of polytrauma and discusses the priorities and processes for managing polytrauma patients, including establishing airway and breathing, controlling circulation through fluid resuscitation, conducting thorough primary and secondary surveys, obtaining diagnostic imaging, and managing specific life-threatening injuries like those involving the head, spine, pelvis or long bones. A team-based approach is emphasized to efficiently evaluate and treat multiple injuries.
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
The Medicine in Remote Areas (MIRA) Manual is a comprehensive guide designed for medical professionals, emergency responders, and individuals operating in isolated and challenging environments. This manual provides essential knowledge and practical skills necessary for delivering effective medical care where traditional medical resources and immediate evacuation are not readily available.
Expertly crafted, the MIRA Manual covers a wide range of topics, including emergency response planning, trauma management, illness diagnosis, and long-term care in remote settings. Readers will find detailed sections on environmental medicine, addressing challenges such as extreme weather conditions, and wilderness first aid techniques. The manual also delves into specific medical conditions and injuries that are likely to be encountered in remote areas, offering step-by-step procedures for treatment and stabilization.
Ideal for expedition medics, military personnel, remote site workers, and adventure enthusiasts, the MIRA Manual is an invaluable resource for anyone responsible for providing medical care in off-grid locations. It combines theoretical knowledge with practical approaches, ensuring that readers are well-equipped to handle a variety of medical situations in remote settings.
- 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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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2. POLYTRAUMA
World wide No.1 killer amongst the younger age group
(18-44 yrs).
Third most common cause of death in all age group.
Great economic & social loss to country.
Less than 2% of budgets for health services spend on
trauma patients.
TRAUMA- Neglected Disease of Modern Society
3. POLYTRAUMA
Defined as “a clinical state following injury to the body leading to
profound physiometabolic changes involving multisystem’’.
OR
Patient with anyone of the following combination of injuries
• TWO MAJOR SYSTEM INJURY + ONE MAJOR LIMB INJURY.
• ONE MAJOR SYSTEM INJURY + TWO MAJOR LIMB INJURY.
• ONE MAJOR SYSTEM INJURY + ONE OPEN GRADE III SKELETAL
INJURY>
• UNSTABLE PELVIS FRACTURE WITH ASSOCIATED VISCERAL INJURY
4. Polytrauma is not synonym of multiple fractures.
Multiple fractures are purely orthopaedic problem as
there is involvement of skeletal system alone.
While in Polytrauma there is involvement of more
than one system,Like associated head/spinal injury, chest
injury, abdominal or pelvic injury.
Polytrauma is a multi-system injury and needs
management by a team of surgeons and
physicians. Orthopaedic surgeon is one of the
team member of trauma unit.
POLYTRAUMA / MULTIPLE FRACTURES
5.
6.
7.
8. LIFE SALAVAGE
50% deaths due to trauma occur before the patient
reaches hospital.
30% occur within 4 hrs of reaching the hospital.
20% occur within next 3 weeks in the hospital.
If preventive measures are taken 70% deaths can be
prevented meaning 30% deaths are nonsalvagable
deaths.
9. AIMS IN MANAGEMENT
“TO RESTORE THE PATIENT BACK TO HIS
PREINJURY STATUS”
HAVING FOLLOWING PRIORTIES:
LIFE SALVAGE
LIMB SALVAGE
SALVAGE OF TOTAL FUNCTION IF POSSIBLE
10. PHILOSOPHY FOR MANAGEMENT
ADVANCED TRAUMA LIFE SUPPORT -- based
on
‘TREAT LETHAL INJURY FIRST, THEN
REASSESS AND TREAT AGAIN’
The steps in management are:
•Primary survey
•Resuscitation
•Secondary survey
•Definitive care
11. TEAM APPROACH
A TEAM consists of:
Anesthetist.
General surgeon
NeuroSurgeon
Orthopedic surgeon
Every team must have a final decision maker,the captain.The
team must be:
a) able to evaluate the patient swiftly.
b)Willing to discuss the effect of the management
of one problem on other.
c) Able to arrive at decisions quickly.
d) Efficient in regard to performing lifesaving procedures .
12. Basic Emergency Medical Skills
1. Maintenance of airway (endotracheal intubation?).
2. Cardiopulmonary resuscitation.
3. Intravenous access and Ringer’s lactate therapy.
4. Reduction and splintage of fractures.
5. Perform primary survey of patient and report findings to
destination center.
PREHOSPITAL PHASE
13. 2 types usually exist
• The number of patients and severity of injuries do not exceed the ability
of facility to render care. IN THIS SITUATION , PATIENTS WITH LIFE-
THREATING PROBLEMS AND THOSE SUSTAINING MULTIPLE SYSTEM
INJURIES ARE TREATED FIRST
• The number of patients and the severity of their injuries exceed the
Capacity of the facility and the staff. IN THIS SITUATION ,THOSE
PATIENTS WITH GREATEST CHANCE OF SURVIVAL , WITH LEAST
EXPENDITURE OF TIME , EQUIPMENTS , SUPPLIES AND PERSONNEL
, ARE MANAGED FIRST
TRIAGE
Triage is the sorting of patients based on the need for
treatment and the available resources to provide that treatment
Ideally must be followed right from the site of the Accident
14. “T HE GO LDE N
HO UR”
The Golden Hour is a theory stating that the best chance
of survival occurs when a seriously injured patient has
emergency management within ONE hour of the injury.
Platinum 10 minutes: Only 10 minutes of the Golden
Hour may be used for on-scene activities
15. PRIMARY SURV E Y
Airway with cervical spine control.
Breathing and ventilation
Circulation –control external bleeding.
Dysfunction of the central nervous system
Exposure (undress)/Environment(temp.)
Control
16. PRIMARY SURVEY
During the primary survey life threatening conditions are
identified and management is instituted SIMULTANEOUSLY.
•Airway obstruction
•Tension pneumothorax
•Hemothorax
•Open thoracic injury and Flail chest
•Cardiac temponade
•Massive internal or External hemorrhage
Priorities for the care of Adult , Pediatrics & Pregnancy women
are all the same.
17. A S S E S S AIRWAY
If pt conscious airway is maintained
Open if necessary using jaw-thrust maneuver
Consider oro- or naso-pharyngeal airway
Note unusual sounds and correct cause
Snoring – oro-/naso-pharyngeal airway
Gurgling – suction
Stridor – consider intubation
18. S IGNS OF AIRWAY
OBSTRUCTION
LOOK
AGITATION
POOR AIR MOVT.
RIB RETRACTION
DEFORMITY
FOREIGN MATERIAL.
LISTEN
SPEECH?”HOW ARE
YOU’’
HOARSENESS.
NOISY BREATHING
GURGLE.
STRIDOR.
FEEL
FRACTURE CREPITUS.
TRACHEAL
DEVIATION.
HEMATOMA.
FACE.
19. DEFINIT IVE AIRWAY
Cuffed tube in trachea secured thoroughly with oxygen
enriched gas supplementation.
Indications for definitive airway-
A=Airway-Obstructed airway.
-Inadequate Gag reflex
B=Breathing-Inadequate breathing.
-oxygen saturation less then 90%.
C=Circulation-systolic BP < 70 mm Hg despite resuscitation.
D=Disability-Coma.
-GCS less then 8/15.
E=Environment-Hypothermia
Core temp<33degree C.
21. *Protection of the spine & spinal cord is the
important management principle.
*Neurological exam alone does not exclude a
cervical spine injury.
*Always assume a cervical spine injury in any pt
with multi-system trauma, especially with an
altered level of consciousness or blunt injury above
the clavicle.
AIRWAY MAINTENANCE
WITH CERVICAL SPINE
PROTECTION
23.
1. cricothyroidotomy
•last resort for airway control.
•Y connector with O2 at 15 l/min.
•Intermittent jet insufflation- sedate
& paralyze, only for 30-45min.
EMERGENCY RESUSC. MEASURES TO MAINTAIN
ADEQUATE AIRWAY AND BREATHING
24.
Intercostal drain
4th or 5th intercostal space,
mid-axillary line
local anaesthetic down to
pleura
‘above the rib below’
blunt dissection. finger
exploration
pass large drain on forceps
superior & posterior.
underwater drain
pursestring suture
EMERGENCY RESUSC. MEASURES TO MAINTAIN
ADEQUATE AIRWAY AND BREATHING
27. CAUSES OF MAJOR
BLEEDING
THE BIG FIVE:
EXTERNAL visual inspection Local Pressure
THORACIC Primary survey
and CXR .
intercostals tube
insertion
PELVIC pelvis X-ray.
Usually self
limiting/ pelvic
ring closure
LONG BONES clinical
examination.
Spontaneously
traction
splintage
ABDOMEN
clinical
findings/exclusion
of
other/USG/CT/DPL
Lapratomy
28. 50% of trauma death are due to head injuries
Simple Mnemonic to describe level of
consciousness
A : Alert
V : Responds to Vocal stimuli
P : Responds to Painful stimuli
U : Unresponsive to all stimuli
Not forget to use also Glasgow Coma Scale.
DISABILITY
( NEUROLOGICAL EVALUATION)
29. GLASGOW COMA SCORE
Eye Opening
Spontaneous 4
To voice 3
To pain 2
None 1
Verbal Response
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
Motor Response
Obeys command 6
Localizes pain 5
Withdrawn (pain) 4
Flexion (pain) 3
Extension (pain) 2
None 1
If GCS < 10 CT head is indicated
Limitations of GCS:-
Does not include pupillary
assessment
Does not identify
abnormal lateralization of
motor response
Minimum score is 3
30. SIGNS OF SEVERE HEAD
INJURY
Unequal pupils
Unequal motor examination
An open head injury with exposed brain
tissue
Neurological deterioration
Depressed skull fracture
These are signs of severe head injury irrespective of CGS score
31. •Patient should be undressed to facilitate thorough
examination.
• Warm environment (room temp) should be maintained
• Intravenous fluid should be warm.
• Early control of hemorrhage.
E. EXPOSURE /
ENVIRONMENTAL CONTROL
32. • Airway
Definite airway if there is any doubt about the pt’s ability to
maintain airway integrity.
A definite airway is a cuffed tube in the trachea.
B. Breathing /Ventilation/Oxygenation
Every multiple injured pt should received supplement oxygen.
A clear distinction must be made between an adequate airway and
adequate breathing.
RESUSCITATION
33. C. Circulation
•Control bleeding by direct pressure or
operative intervention
•Minimum of two large caliber IV(16G)
should be established
•Lactated Ringer is preferred & better
if warm.
RESUSCITATION
34. Children less than 6 y/o for IV
access is impossible due to
circulatory collapse or for whom
percutaneous peripheral venous
cannulation had failed on two
attempt
Venescetion
•Greater saphenous vein 2cm ant
and superior to medial malleolus
•Antecubital medial basilic vein
2cm lateral to medial epicondyle
INTRAOSSEOUS
PUNCTURE/INFUSION
36. 3 FOR 1
RULE
a rough guideline for the total amount
of crystalloid volume acutely is to
replace each ML of blood loss with 3 ML
of crystalloid fluid, thus allowing for
restitution of plasma volume lost into
the interstitial & intracellular space
AB+
37. RESPONSE TO
EARLY RESUSCITATION
MONITER:
•PULSE.
•BP.
•SKIN -
PERFUSION.
•CONSCIOUSNESS
•URINE OUTPUT.
•-ABGs
RAPID
RESPONSE
BE CAREFULL ,MAY
STILL BECOME
UNSTABLE AGAIN.
& REQUIRE
SURGERY .
TRANSIENT
RESPONSE
STOP THE
BLEEDING.
MINIMAL
RESPONSE
REMEMBER
THE “BIG 5”’
-GO TO O.T.
ADVERSE
RESPONSE
•COAGULOPATHY.
•HYPOTHERMIA
•UNDER RESUSCITATION
38. PHYSICAL
AMPLE HIS TO RY
A – allergies
M – medications
P – past medical history
L – last oral intake
E – events leading up to the incident
39. ADJUNCT TO PRIMARY S URVEY &
RESUSCITATION
A. Electro-cardiographic Monitoring
B. Urinary & Gastric Catheter
C. X-Ray & Diagnostic Studies
C-spine lateral , CXR, Pelvic film (TRAUMA SERIES)
Essential x-ray should NOT be avoid in pregnant pt.
40. S ECONDARY S URVEY
•Does not begin until the primary survey (ABCDEs) is
completed, resuscitative effort are well established & the
pt is demonstrating normalization of vital sign.
•Head to Toe evaluation & reassessment of all vital
signs.
•A complete neurological exam is performed including a
GCS score.
• Special procedure is order.
41. 7. ADJUNCT TO THE SECONDARY
SURVEY
include additional x-ray and all other special
procedure.
8. RE-EVALUATION
Adult urine output 1ml/kg/hr
Pediatric urine output 1ml/kg/hr
9. DEFINITE CARE
42. END POINT OF
RESUSCITATION
Stable hemodynamics
Stable oxygen saturation
Lactate level below 2 mmol / L
No cogaulation disturbance
Normal temp
Urinary output > 1ml /kg/hr
No requirement of inotropic support
43. POLYTRAUMA IN PREGNANT
FEMALE
• TREATMENT PRIORITIES ARE SAME AS FOR
NON PREGNANT PT
• UNLESS SPINAL INJURY IS PRESENT PT
SHOULD BE EXAMINED IN LEFT
LATERAL POSITION
• PT CAN LOOSE UPTO 35%OF BLOOD
BEFORE TACHYCARDIA AND HYPOTENSION
APPEARS
• FETUS MAY BE IN SHOCK WHILE MOTHER
APPEARS NORMAL
1st resuscitate the female than monitor the fetus
45. SPINAL
INJURIES
Any pt suspected of
spinal injury must
be immobilised
unless spine has
been cleared
Cervical collar
Spine board
Log roll technique
Log roll technique
46. Neurological shock (Low BP & HR)
Spinal shock - Flaccid areflexia
Flexed upper limbs (loss of extensor innervation below
C5)
Responds to pain above the clavicle only
Diaphragmatic breathing
SIGNS IN AN UNCONCIOUS
PATIENTS
47. SPINE CLEARANCE
Purpose:
to identify accurately and early following blunt injury to the spine
the presence or absence of a diagnosis of spinal column injury
Ensure that
There is no spinal injury to produce avoidable disabiity or symtomps
There is no important Fracture
We avoid overprotection with its attendant risk
In all pt consistent with spinal injury maintain spinal preacutions
untill thorough clinical and radiographic evaluation of spine is
completed
48. PELVIC
INJURIES
Pelvic injury is one of few bony injury that can lead to pt death
Pelvic injuries are assesed during secondary survey
Pelvis x ray is mandatory in polytrauma pt
Can lead to life threatening hemorrhage
Open pelvic # 50% mortality
Uretheral injury transurtheral catheter or suprapubic catheter
51. DEFINITIONS OF PT
CONDITIONS
Stable
Borderline
no life threatening injuries,
haemodynamically stable
intially respond to
resuscitation but can
deteriorate
remain haemodynamically
unstable despite initial
resuscitation
close to death uncontrollable
blood loss
Unstable
Extremis
52. EARLY TOTAL CARE
(ETC)
That is defenitive fracture treatment within 24
hr ,unreamed nail prefered
Used in stable pts
Avoid in severe thoracic injuries
haemorrhagic shock
head injury
Advantage pain relief , less infection, eary
mobilisation, dec throemboembolism
53. DAMAGE
CONTROL
Described by us navy as the capacity of ship to absorb damge
and maintain integrity
Polytrauma pts means that surgical tratements intends to control
but not to defenitively repair the trauma induced injuries early
after trauma
Used in unstable and extremis pts
54. DAMAGE CONT ROL
•Stage 1:Minimum surgery is done
• achieve haemostasis.
•Limit the contamination
•Temporary stabilisation of unstable fractures
•Stage 2:Physiological restoration in ICU.
•Stage 3:Return to operation theatre for definitive
surgery.
55. DAMAGE CONTROL
SURGERY
(“STAGED LAPROTOMY”)
•Arrest bleeding , and the resulting coagulopathy.
• Limit contamination and the sequelae .
• Close the abdomen to limit heat and fluid
loss, and to protect viscera.
Damage control orthopaedics
1st stage temporary stabilisation of #
2nd stage resuscitation and optimisation
3rd stage definitive fracture fixation
•External fixator is most commonly used for temporary stabilisation
•Change to definitive # fixation is done in 2nd week
56. CONCLUS ION
Favorable outcome for a critically injured patient
demands an integrated team effort.
Initial treatment is dictated by patient’s immediate
physiologic requirement for survival.
The definitive treatment requires rapid assessment
and life preserving therapy.
Damage control surgery should have a defined place
in surgeons armamentarium.