Polytrauma, or multiple severe injuries, is a leading cause of death worldwide especially among younger people. It involves injury to multiple body systems. Effective management requires a team-based approach that focuses on stabilizing the airway, breathing, and circulation during the primary survey before addressing specific injuries. The goals are to save the patient's life, preserve limbs if possible, and restore full function. Rapid assessment and treatment in the first hour, known as the "golden hour", significantly improves chances of survival.
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.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
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.
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
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.
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
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.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
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.
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
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.
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
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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.
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.
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
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
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. 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 .
TEAM APPROACH
Anesthetist.
General surgeon
NeuroSurgeon
Orthopedic surgeon
A TEAM consists of:
12. Basic Emergency Medical Technician 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
1. 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
2. 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. “The Golden Hour”
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 Survey
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 SURVERY
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. Assess 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
19. DEFINITIVE 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. WHEN TO VENTILATE? Apnoea
Hypoventilation.
Flail chest.
High Spinal cord injury.
Diaphragmatic injury.
Head injury GCS < 8
Hypercapnia.
Hypothermia.
22. *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
24. 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
25. 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
28. 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
29. Positive if
Bile or intestinal contents
More than 20ml frank blood aspirated
prior to running in the lavage fluid
After infusion of the fluid, more than
100,000 red cells/mm3 (blunt trauma) or
10-50,000/mm2 (penetrating trauma)
Elevated amylase
WBC > 500 / mm3
DIAGNOSTIC PERITONEAL LAVAGE (CLOSED TECHNIQUE)
30. 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)
31. Glasgow Coma Score
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
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
32. 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
33. • 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
34. A.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
35. 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
36. 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
38. 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
39. 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
40. Focused History and Physical
AMPLE History
A – allergies
M – medications
P – past medical history
L – last oral intake
E – events leading up to the incident
41. ADJUNCT TO PRIMARY SURVEY &
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.
42. SECONDARY SURVEY
• 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.
43. 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
44. 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
45. Polytrauma in pregnant female
Tratement priorities are same as for non pregnant pt
Unless spinal injury is present pt should be
examined in left lateral position
Pt can loss 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
47. 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
48. 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
Priapism – may be incomplete.
Diaphragmatic breathing
Signs in an Unconcious patients
49. 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
50. 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
53. Definitions of pt conditions
Stable no life threatening injuries,
haemodynamically stable
Borderline intially respond to
resuscitation but can
deteriorate
Unstable remain haemodynamically
unstable despite initial
resuscitation
Extremis close to death uncontrollable
blood loss
54. Early total care (ETC)
That is defenitive fracture tretement 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
55. 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
56. DAMAGE CONTROL
•Stage 2:Physiological restoration in ICU.
•Stage 3:Return to operation theatre for definitive
surgery.
•Stage 1:Minimum surgery is done
• achieve haemostasis.
•Limit the contamination
•Temporary stabilisation of unstable fractures
57. 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
59. CONCLUSION
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.
60. POLYTRAUMA
In an injury with multiple fractures, most important is
a. Airway
b. Blood Transfusion
c. IV fluids
d. Open reduction of fractures
2. Correct order of priority in management of head injury is
a. Airway, breathing, circulation, treatment of extra-cranial injuries
b. treatment of extra-cranial injuries, Airway, breathing, circulation
c. breathing, circulation, treatment of extra-cranial injuries, Airway
d. circulation, treatment of extra-cranial injuries, Airway, breathing
3. Severely injured patient with spinal fractures and unconsciousness,
first thing to do is ?
a. Airway
b. GCS scoring
c. Manniotl drip
d. Spinal stabilizationby cervical collar
61. 4. Patient comes with fracture femur in acute accident, first thing
to do is
a. Secure airway and treat shock
b. Splinting
c. Physical examination
d. X-rays
5. Tetanus is usually noticed in
a. Burns
b. Open fractures
c. Gunshot wounds
d. All of the above
6. Which of the following is not a component of crush syndrome ?
a. Myohemoglobinuria
b. Massive crushing of muscles
c. Acute tubular necrosis
d. Bleeding diathesis
62. 7. Of the following signs – pallor, restlessness, air hunger and water
hammer pulse, hemorrhagic shock includes
a. 1and 4
b. 1 and 2
c. 1,2 and 4
d. 2,4 and 4
8. Compound fracture is initially treated by antibiotics, wound toilet and
a. Skin cover
b. External splint
c. Prosthesis
d. Internal fixation
9. Tarsometatarsal amputation is known as
a. Choparts amputation
b. Lisfranc amputation
c. Symes amputation
d. Powells amputation
63. 10. Compound fracture is
a. Fracture with artery involvement
b. Fracture with nerve involvement
c. Fracture with muscle involvement
d. Fracture with skin involvement