This document provides an overview of primary care in trauma. It discusses the primary and secondary surveys, with a focus on assessing and managing the ABCs - Airway, Breathing, and Circulation. For the airway, it describes techniques for opening and maintaining the airway as well as mechanical airway devices and surgical procedures. For breathing, it discusses signs of respiratory distress and management of pneumothorax, hemothorax, and flail chest. For circulation, it outlines assessing pulses, capillary refill, and skin signs to evaluate circulation and control hemorrhage. The goal is to accurately and systematically assess and address any immediate life threats.
Assess breathing by looking, listening and feeling.
Look for chest rise and fall, respiratory effort and symmetry.
Listen over the chest, back and upper abdomen.
Feel for breath sounds with your hand or stethoscope.
Manage life-threatening causes of inadequate breathing such as tension pneumothorax or flail chest.
C: Circulation
Pre operative assessment of patient schedule for oral surgeryNuhafadhil
This document discusses pre-operative assessment and risk assessment for oral surgery patients. It covers evaluating four key components: the patient's medical condition, functional capacity, emotional status, and the planned procedure. A thorough medical history is essential to determine if a medically compromised patient can safely undergo the planned procedure. The document then examines risk factors and considerations for patients with cardiovascular diseases, hematologic disorders, and respiratory diseases. It provides examples of how certain conditions may require modifications to dental treatment or precautions with certain medications.
This document provides information on midfacial fractures, including the LeFort classifications. It describes:
1) The LeFort I, II, and III fracture patterns involving the maxilla and midface bones. LeFort I involves the maxilla, LeFort II separates the midface, and LeFort III separates the entire midface from the skull.
2) Clinical signs of each type include swelling, mobility of teeth, and malocclusion for LeFort I; moon face and raccoon eyes for LeFort II; and severe edema and flattening of the cheeks for LeFort III.
3) Treatment involves reducing and fixing the fractures, usually through closed or open reduction using manual manipulation or specialized instruments to re
This document discusses condylar fractures of the mandible. It begins by providing background on condylar fracture development, anatomy, surgical anatomy, blood supply, nerve supply and muscle attachments. It then covers the etiology, associated injuries, mechanisms of injury and various classification systems for condylar fractures. The document outlines the diagnosis process including history, clinical examination and radiographic imaging. It concludes by discussing treatment approaches, focusing on the aims of surgery and indications for conservative versus surgical management.
The document discusses the history, anatomy, classification, examination, diagnosis, and treatment of mandibular fractures. It traces the history from descriptions in ancient texts to modern techniques. The mandible has a unique anatomy as a bent bone that provides both compression and tension zones. Fractures are classified in various ways including by location, number of fragments, involvement of surrounding tissues, and relation to occlusion. Clinical examination involves inspection, palpation, and neurological and range of motion tests while radiographs help confirm and characterize fractures.
This document discusses the anatomy, classification, etiology, clinical features, and management of mid-face fractures. It begins with an overview of the bones that make up the mid-face region. It then covers the Le Fort fracture classification system and describes the clinical features of Le Fort I, II, and III fractures. The document concludes with a discussion of treatment approaches for mid-face fractures including closed and open reduction as well as various fixation techniques.
Ludwig’s angina is a life-threatening infection with associated compromised airway and is an emergency in OMFS. Airway management is the primary concern in this situation
Assess breathing by looking, listening and feeling.
Look for chest rise and fall, respiratory effort and symmetry.
Listen over the chest, back and upper abdomen.
Feel for breath sounds with your hand or stethoscope.
Manage life-threatening causes of inadequate breathing such as tension pneumothorax or flail chest.
C: Circulation
Pre operative assessment of patient schedule for oral surgeryNuhafadhil
This document discusses pre-operative assessment and risk assessment for oral surgery patients. It covers evaluating four key components: the patient's medical condition, functional capacity, emotional status, and the planned procedure. A thorough medical history is essential to determine if a medically compromised patient can safely undergo the planned procedure. The document then examines risk factors and considerations for patients with cardiovascular diseases, hematologic disorders, and respiratory diseases. It provides examples of how certain conditions may require modifications to dental treatment or precautions with certain medications.
This document provides information on midfacial fractures, including the LeFort classifications. It describes:
1) The LeFort I, II, and III fracture patterns involving the maxilla and midface bones. LeFort I involves the maxilla, LeFort II separates the midface, and LeFort III separates the entire midface from the skull.
2) Clinical signs of each type include swelling, mobility of teeth, and malocclusion for LeFort I; moon face and raccoon eyes for LeFort II; and severe edema and flattening of the cheeks for LeFort III.
3) Treatment involves reducing and fixing the fractures, usually through closed or open reduction using manual manipulation or specialized instruments to re
This document discusses condylar fractures of the mandible. It begins by providing background on condylar fracture development, anatomy, surgical anatomy, blood supply, nerve supply and muscle attachments. It then covers the etiology, associated injuries, mechanisms of injury and various classification systems for condylar fractures. The document outlines the diagnosis process including history, clinical examination and radiographic imaging. It concludes by discussing treatment approaches, focusing on the aims of surgery and indications for conservative versus surgical management.
The document discusses the history, anatomy, classification, examination, diagnosis, and treatment of mandibular fractures. It traces the history from descriptions in ancient texts to modern techniques. The mandible has a unique anatomy as a bent bone that provides both compression and tension zones. Fractures are classified in various ways including by location, number of fragments, involvement of surrounding tissues, and relation to occlusion. Clinical examination involves inspection, palpation, and neurological and range of motion tests while radiographs help confirm and characterize fractures.
This document discusses the anatomy, classification, etiology, clinical features, and management of mid-face fractures. It begins with an overview of the bones that make up the mid-face region. It then covers the Le Fort fracture classification system and describes the clinical features of Le Fort I, II, and III fractures. The document concludes with a discussion of treatment approaches for mid-face fractures including closed and open reduction as well as various fixation techniques.
Ludwig’s angina is a life-threatening infection with associated compromised airway and is an emergency in OMFS. Airway management is the primary concern in this situation
This document provides an overview of cleft lip and palate, including:
- The incidence is approximately 1 in 700 live births. Males are more commonly affected by cleft lip while females are more commonly affected by cleft palate.
- Clefts occur due to both genetic and environmental factors like certain viruses, medications, and smoking. They may also be associated with other syndromes.
- Clefts are classified based on their location and severity, with unilateral cleft lip and palate (UCLP) being one of the most common types.
- Individuals with cleft lip and palate can experience problems with feeding, speech, hearing, and psychosocial issues. Timely management including
This document provides an overview of secondary alveolar bone grafting for cleft lip and palate patients. It discusses the goals and optimal timing of the procedure, how patients are evaluated, and details regarding graft source options including iliac crest, tibia, rib, and cranial bone. It also covers pre-surgical orthodontics and preparation of the cleft alveolus, as well as post-operative care considerations.
This document discusses the radiological aspects of oral and maxillofacial surgery. It begins by introducing oral and maxillofacial radiology and classifying radiographic techniques into conventional and specialized radiography. Under conventional radiography, it describes various intraoral and extraoral techniques like periapical, occlusal, panoramic, and cephalometric radiographs. It then explains specialized radiography techniques like CT, MRI, ultrasound and sialography. It provides details on the indications, anatomy visualized, and appearance of common pathologies on different radiographs. In conclusion, the document emphasizes that radiographs are important diagnostic tools in oral and maxillofacial surgery for evaluating diseases, fractures and designing treatment plans.
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
This document provides an overview of Lefort I osteotomy, including:
- A brief history describing the development of maxillary osteotomy techniques.
- Anatomical considerations and the biologic basis for maxillary osteotomies, which have shown adequate blood supply can be maintained.
- Indications for Lefort I osteotomy include altering vertical dimension, anteroposterior movements, and surgical expansion of the maxilla.
- Types of Lefort I osteotomies are described, including classic, quadrangular, and segmental variations. Postoperative management and potential complications are also outlined.
Fractures of the zygomatic complex are common facial injuries that often involve displacement of the zygomatic bone from its normal position. Clinical examination involves inspection for deformities and palpation of the zygomatic bone and arch. Radiographic evaluation with CT scanning is important to fully assess the fracture pattern and displacement. Successful management requires accurate reduction and fixation of the zygomatic bone to restore facial contour and function.
The pectoralis major flap uses the pectoralis major muscle and overlying skin to reconstruct head and neck defects. It has a reliable blood supply from the thoracoacromial artery. The muscle is raised from the chest wall and tunneled to the defect site. The skin paddle size and position can be adjusted depending on the location and size of the defect. Complications are rare but include infection, partial flap necrosis, and donor site issues. It provides a bulky well-vascularized tissue for reconstruction with minimal morbidity.
The document provides an overview of various mandibular osteotomy techniques used in orthognathic surgery. It discusses the history, indications, techniques, advantages, disadvantages, and complications of bilateral sagittal split osteotomy (BSSO), internal vertical ramus osteotomy, body osteotomies, subapical osteotomies, and genioplasty. BSSO is one of the most common techniques described, allowing advancement, setback, or rotation of the mandible with minimal soft tissue stripping, though it carries risks of nerve injury, malocclusion, and relapse. Alternative techniques such as internal vertical ramus osteotomy are discussed as being easier but providing less control over condylar positioning.
Ludwig's angina is a severe bacterial infection of the submandibular, sublingual, and submental spaces that can lead to airway obstruction if left untreated. It is usually caused by dental infections. Clinically, it presents with a firm, brawny swelling of the neck and floor of the mouth, accompanied by fever, malaise, and difficulty opening the mouth. Aggressive treatment involves securing the airway, administering IV antibiotics, and performing surgical incision and drainage. Without treatment, Ludwig's angina can prove fatal within 1-2 days due to asphyxiation or sepsis.
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
Assessment of difficulty of mandibular impacted third molarDr. Preeti Satish
This document provides an overview of assessing the difficulty of removing mandibular impacted third molars. It discusses the importance of a thorough history and clinical/radiographic examination to determine factors like depth, position, root morphology and proximity to anatomical structures that can influence difficulty. A standardized index uses Winter's lines on radiographs to classify depth as predictive of difficulty, with deeper impactions requiring more bone removal and posing greater challenges. A multifactorial assessment allows for an individualized treatment plan.
Ludwig's angina is a serious neck infection that can compromise the airway. It involves the sublingual and submandibular spaces and spreads through connective tissue planes. The infection is usually polymicrobial, involving bacteria like Streptococcus and Staphylococcus. It commonly originates from an odontogenic infection. Symptoms include neck swelling, difficulty swallowing and breathing. Immediate priorities in treatment are airway protection through intubation or tracheostomy and IV antibiotics.
This document provides information on nasal fractures, including:
- Nasal fractures are the most common facial fracture, caused by physical assaults, falls, motor vehicle accidents, or contact sports.
- Left untreated, nasal fractures can lead to long-term deformities, obstruction, and other complications. Proper evaluation and management can reduce these risks.
- Evaluation involves history, examination of external and internal nasal structures, and sometimes imaging like x-rays or CT scans.
- Initial treatment focuses on controlling bleeding and drainage. Closed reduction is preferred but open reduction may be needed for severe fractures.
- Proper timing of reduction is important to realign fragments before fibrous tissue forms. Anest
- Mandibular fractures are common injuries that may be encountered by dental surgeons. They can be classified based on type, site, and cause of the fracture.
- Signs and symptoms depend on the specific site of the fracture and may include pain, swelling, limitation of mouth opening, and malocclusion. Radiographs are important for diagnosis.
- Management involves addressing the airway, hemorrhage, and pain. Definitive treatment consists of reduction to realign fragments followed by immobilization to allow bone healing, which depends on the stability and mobility at the fracture site. Teeth in the line of fracture may require extraction.
This document provides guidance on assessing and treating facial trauma. It outlines the standard clinical assessment process, including taking a history, performing a general external and neurologic examination, and examining specific areas like the orbit, nose, ears, and occlusion. It then describes common facial bone injuries like nasal, orbital floor, zygomatic, and mandibular fractures. The document concludes with information on classifying facial fractures, local anesthetics used in facial procedures, and guidelines for referring patients with facial fractures to the emergency department for CT imaging and follow-up care.
This document discusses complications that can occur during and after oral surgery procedures. It describes various types of complications including injuries to adjacent teeth or soft tissues, nerve injuries, hemorrhage, displacement of teeth or root tips, fractures of the jaw or alveolar process, and oroantral communications. It also discusses the causes, signs, and treatments for each complication.
This document discusses various types of facial bone fractures including the nasal bones, maxilla, zygomatic bones, and mandible. It describes the common causes of facial fractures such as road traffic accidents, falls, assaults, and sports injuries. The key aspects of managing facial trauma are controlling airway, hemorrhage, and treating associated injuries. Examination involves checking specific areas of the face. Treatment options depend on the type and severity of the fracture and may include closed or open reduction as well as splinting or internal fixation with plates or screws.
AIRWAY AND VENTILATORY MANAGEMENT OF TRAUMA PATIENTS 1 -.pptxmohit946459
- Airway and ventilatory management is critical in trauma patients to prevent hypoxia. Situations that can lead to airway compromise include head, neck, facial, and laryngeal trauma.
- Objective signs of airway obstruction or inadequate ventilation such as noisy breathing, hypoxia, and hypercarbia must be quickly recognized.
- Techniques for maintaining a patent airway include basic airway maneuvers, oropharyngeal/nasopharyngeal airways, and more advanced techniques like endotracheal intubation when needed. Cervical spine restriction is also important.
- Adequate oxygenation and ventilation must be continuously monitored and supported through oxygen supplementation, bag-mask ventilation,
The document discusses surgical airways, including a brief history, relevant anatomy, classifications, indications, techniques, and complications. Surgical airways such as tracheostomy and cricothyrotomy are performed when intubation is impossible or contraindicated to bypass upper airway obstruction and provide long-term ventilation. Complications include bleeding, infection, and stenosis if not performed properly. Tracheostomy involves making an opening in the trachea while cricothyrotomy is through the cricothyroid membrane as a temporary measure until a definitive airway is established.
This document provides an overview of cleft lip and palate, including:
- The incidence is approximately 1 in 700 live births. Males are more commonly affected by cleft lip while females are more commonly affected by cleft palate.
- Clefts occur due to both genetic and environmental factors like certain viruses, medications, and smoking. They may also be associated with other syndromes.
- Clefts are classified based on their location and severity, with unilateral cleft lip and palate (UCLP) being one of the most common types.
- Individuals with cleft lip and palate can experience problems with feeding, speech, hearing, and psychosocial issues. Timely management including
This document provides an overview of secondary alveolar bone grafting for cleft lip and palate patients. It discusses the goals and optimal timing of the procedure, how patients are evaluated, and details regarding graft source options including iliac crest, tibia, rib, and cranial bone. It also covers pre-surgical orthodontics and preparation of the cleft alveolus, as well as post-operative care considerations.
This document discusses the radiological aspects of oral and maxillofacial surgery. It begins by introducing oral and maxillofacial radiology and classifying radiographic techniques into conventional and specialized radiography. Under conventional radiography, it describes various intraoral and extraoral techniques like periapical, occlusal, panoramic, and cephalometric radiographs. It then explains specialized radiography techniques like CT, MRI, ultrasound and sialography. It provides details on the indications, anatomy visualized, and appearance of common pathologies on different radiographs. In conclusion, the document emphasizes that radiographs are important diagnostic tools in oral and maxillofacial surgery for evaluating diseases, fractures and designing treatment plans.
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
This document provides an overview of Lefort I osteotomy, including:
- A brief history describing the development of maxillary osteotomy techniques.
- Anatomical considerations and the biologic basis for maxillary osteotomies, which have shown adequate blood supply can be maintained.
- Indications for Lefort I osteotomy include altering vertical dimension, anteroposterior movements, and surgical expansion of the maxilla.
- Types of Lefort I osteotomies are described, including classic, quadrangular, and segmental variations. Postoperative management and potential complications are also outlined.
Fractures of the zygomatic complex are common facial injuries that often involve displacement of the zygomatic bone from its normal position. Clinical examination involves inspection for deformities and palpation of the zygomatic bone and arch. Radiographic evaluation with CT scanning is important to fully assess the fracture pattern and displacement. Successful management requires accurate reduction and fixation of the zygomatic bone to restore facial contour and function.
The pectoralis major flap uses the pectoralis major muscle and overlying skin to reconstruct head and neck defects. It has a reliable blood supply from the thoracoacromial artery. The muscle is raised from the chest wall and tunneled to the defect site. The skin paddle size and position can be adjusted depending on the location and size of the defect. Complications are rare but include infection, partial flap necrosis, and donor site issues. It provides a bulky well-vascularized tissue for reconstruction with minimal morbidity.
The document provides an overview of various mandibular osteotomy techniques used in orthognathic surgery. It discusses the history, indications, techniques, advantages, disadvantages, and complications of bilateral sagittal split osteotomy (BSSO), internal vertical ramus osteotomy, body osteotomies, subapical osteotomies, and genioplasty. BSSO is one of the most common techniques described, allowing advancement, setback, or rotation of the mandible with minimal soft tissue stripping, though it carries risks of nerve injury, malocclusion, and relapse. Alternative techniques such as internal vertical ramus osteotomy are discussed as being easier but providing less control over condylar positioning.
Ludwig's angina is a severe bacterial infection of the submandibular, sublingual, and submental spaces that can lead to airway obstruction if left untreated. It is usually caused by dental infections. Clinically, it presents with a firm, brawny swelling of the neck and floor of the mouth, accompanied by fever, malaise, and difficulty opening the mouth. Aggressive treatment involves securing the airway, administering IV antibiotics, and performing surgical incision and drainage. Without treatment, Ludwig's angina can prove fatal within 1-2 days due to asphyxiation or sepsis.
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
Assessment of difficulty of mandibular impacted third molarDr. Preeti Satish
This document provides an overview of assessing the difficulty of removing mandibular impacted third molars. It discusses the importance of a thorough history and clinical/radiographic examination to determine factors like depth, position, root morphology and proximity to anatomical structures that can influence difficulty. A standardized index uses Winter's lines on radiographs to classify depth as predictive of difficulty, with deeper impactions requiring more bone removal and posing greater challenges. A multifactorial assessment allows for an individualized treatment plan.
Ludwig's angina is a serious neck infection that can compromise the airway. It involves the sublingual and submandibular spaces and spreads through connective tissue planes. The infection is usually polymicrobial, involving bacteria like Streptococcus and Staphylococcus. It commonly originates from an odontogenic infection. Symptoms include neck swelling, difficulty swallowing and breathing. Immediate priorities in treatment are airway protection through intubation or tracheostomy and IV antibiotics.
This document provides information on nasal fractures, including:
- Nasal fractures are the most common facial fracture, caused by physical assaults, falls, motor vehicle accidents, or contact sports.
- Left untreated, nasal fractures can lead to long-term deformities, obstruction, and other complications. Proper evaluation and management can reduce these risks.
- Evaluation involves history, examination of external and internal nasal structures, and sometimes imaging like x-rays or CT scans.
- Initial treatment focuses on controlling bleeding and drainage. Closed reduction is preferred but open reduction may be needed for severe fractures.
- Proper timing of reduction is important to realign fragments before fibrous tissue forms. Anest
- Mandibular fractures are common injuries that may be encountered by dental surgeons. They can be classified based on type, site, and cause of the fracture.
- Signs and symptoms depend on the specific site of the fracture and may include pain, swelling, limitation of mouth opening, and malocclusion. Radiographs are important for diagnosis.
- Management involves addressing the airway, hemorrhage, and pain. Definitive treatment consists of reduction to realign fragments followed by immobilization to allow bone healing, which depends on the stability and mobility at the fracture site. Teeth in the line of fracture may require extraction.
This document provides guidance on assessing and treating facial trauma. It outlines the standard clinical assessment process, including taking a history, performing a general external and neurologic examination, and examining specific areas like the orbit, nose, ears, and occlusion. It then describes common facial bone injuries like nasal, orbital floor, zygomatic, and mandibular fractures. The document concludes with information on classifying facial fractures, local anesthetics used in facial procedures, and guidelines for referring patients with facial fractures to the emergency department for CT imaging and follow-up care.
This document discusses complications that can occur during and after oral surgery procedures. It describes various types of complications including injuries to adjacent teeth or soft tissues, nerve injuries, hemorrhage, displacement of teeth or root tips, fractures of the jaw or alveolar process, and oroantral communications. It also discusses the causes, signs, and treatments for each complication.
This document discusses various types of facial bone fractures including the nasal bones, maxilla, zygomatic bones, and mandible. It describes the common causes of facial fractures such as road traffic accidents, falls, assaults, and sports injuries. The key aspects of managing facial trauma are controlling airway, hemorrhage, and treating associated injuries. Examination involves checking specific areas of the face. Treatment options depend on the type and severity of the fracture and may include closed or open reduction as well as splinting or internal fixation with plates or screws.
AIRWAY AND VENTILATORY MANAGEMENT OF TRAUMA PATIENTS 1 -.pptxmohit946459
- Airway and ventilatory management is critical in trauma patients to prevent hypoxia. Situations that can lead to airway compromise include head, neck, facial, and laryngeal trauma.
- Objective signs of airway obstruction or inadequate ventilation such as noisy breathing, hypoxia, and hypercarbia must be quickly recognized.
- Techniques for maintaining a patent airway include basic airway maneuvers, oropharyngeal/nasopharyngeal airways, and more advanced techniques like endotracheal intubation when needed. Cervical spine restriction is also important.
- Adequate oxygenation and ventilation must be continuously monitored and supported through oxygen supplementation, bag-mask ventilation,
The document discusses surgical airways, including a brief history, relevant anatomy, classifications, indications, techniques, and complications. Surgical airways such as tracheostomy and cricothyrotomy are performed when intubation is impossible or contraindicated to bypass upper airway obstruction and provide long-term ventilation. Complications include bleeding, infection, and stenosis if not performed properly. Tracheostomy involves making an opening in the trachea while cricothyrotomy is through the cricothyroid membrane as a temporary measure until a definitive airway is established.
UPPER AIRWAY OBSTRUCTION GROUP A-1.pptxkelvinamin12
Upper airway obstruction can be acute or chronic, congenital or acquired, and can range from mild to life-threatening if not treated. The upper airway includes the nasal cavities, oral cavity, pharynx, and larynx. Etiologies of obstruction include congenital abnormalities, infections, tumors, trauma, allergic reactions, and foreign body aspiration. Symptoms include dyspnea, stridor, cyanosis, and anxiety. Evaluation involves history, physical exam including endoscopy, and imaging tests. Management secures the airway through endotracheal intubation, tracheostomy, or cricothyrotomy and treats the underlying cause medically or surgically. Tracheostomy is indicated
1. Trauma is a leading cause of death, especially for those aged 1-44. The Advanced Trauma Life Support (ATLS) protocol emphasizes interventions in the "golden hour" to prevent death.
2. The initial evaluation of an injured patient follows the ABCs - Airway, Breathing, and Circulation. Airway management requires cervical spine protection. Tension pneumothorax and open pneumothorax require tube thoracostomy. Circulation assessment focuses on hemorrhage control through intravenous access, wound packing, and identifying life-threatening internal bleeding.
3. Proper application of the ATLS protocol during the initial trauma evaluation focuses on rapid identification and treatment of immediate threats to life
1) Chest injuries account for 20-25% of all trauma deaths and are a leading cause of death worldwide. Life-threatening conditions include tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, and cardiac tamponade.
2) Tension pneumothorax requires immediate needle decompression without waiting for imaging if suspected clinically. Open pneumothorax is managed with an occlusive dressing.
3) Flail chest involves fractures of 3 or more ribs in two places, leading to paradoxical chest wall movement and impaired ventilation. Massive hemothorax involves over 1.5L of blood drained by chest tube or more than 200cc/hour
- Tracheostomy is a surgical procedure that creates an opening in the neck to place a tube into the windpipe (trachea) to allow air to enter the lungs.
- There are different types depending on factors like whether it is temporary or permanent, the location on the trachea, and the cause.
- Indications include upper airway obstruction, need for pulmonary ventilation, pulmonary toilet, and some elective procedures.
- The procedure involves identifying landmarks, making an incision, opening the trachea, inserting a tracheostomy tube, and securing it. Complications can include bleeding, infection, and tracheal damage.
airway management in trauma patients can be particularly challenging because of the presence of difficult airway and disrupted anatomy.
Anatomical implications, airway assessment in trauma, airway management, helpful airway devices were all mentioned in this presentation.
This document provides information on airway management in trauma patients. It begins with an introduction on the challenges of airway management in trauma and importance of proper techniques. It then covers anatomical considerations for the nasal cavity, oral cavity, larynx and potential injuries. It discusses mechanisms of trauma, tools for airway assessment including history, examination and imaging. Guidelines are provided for conventional and difficult airway management techniques, as well as considerations for specific injuries like maxillofacial trauma, penetrating neck injuries and cervical spine injuries. Finally, it reviews helpful airway devices including supraglottic airways, laryngoscopes and fiberoptic scopes that can aid in airway management of trauma patients.
Thoracic surgery refers to operations on the organs in the chest including the heart, lungs, and esophagus. The document discusses various types of thoracic surgeries like lobectomy, pneumonectomy, wedge resection, and lung transplant that are performed to diagnose, treat, or repair conditions of the lungs. It also covers surgeries related to the heart like pericardiectomy and esophageal surgeries like esophagectomy. Important aspects of pre-operative, intra-operative and post-operative nursing management are outlined with a focus on airway maintenance, respiratory monitoring, coughing exercises, and chest tube care.
1) Maxillofacial surgery involves procedures on the head, neck, face and jaws to correct congenital deformities, injuries, tumors, or for cosmetic reasons.
2) Anesthesia for maxillofacial surgery presents several challenges including a shared airway, risk of difficult intubation, significant blood loss, and hemodynamic changes.
3) Careful preoperative evaluation and planning is important to optimize the patient's condition and anticipate any airway issues. Induced hypotension during surgery can help reduce blood loss.
This document discusses trauma to the ear and upper aerodigestive tract. It covers injuries to various parts of the ear including the auricle, ear canal, and middle ear. It also discusses trauma to the larynx and pharynx, as well as caustic ingestion injuries. Key points include the importance of airway management for penetrating pharyngeal or tracheal trauma. Evaluation of ear injuries includes assessing for facial nerve weakness or signs of temporal bone fracture. Management depends on the type and severity of the injury.
Chest injuries and related medical conditions.pptxcolmanny
Chest injuries are a major cause of trauma deaths, responsible for about 25% of cases. Blunt chest trauma can cause rib fractures and damage to internal organs from compression or shearing forces. Pneumothorax, hemothorax, pulmonary contusion, and flail chest are common blunt chest injuries. Tension pneumothorax requires immediate needle decompression to relieve pressure on the heart and lungs. Management involves stabilizing injuries, treating pain, and supporting breathing with oxygen, ventilation, or chest drainage as needed based on the specific injuries present.
1) Airway management is a core skill in emergency medicine and the emergency physician has primary responsibility for airway management. Intubation should be considered when the airway cannot be protected or ventilated, or if clinical deterioration is anticipated.
2) Assessing the airway includes evaluating level of consciousness, ability to phonate, handle secretions, and anticipated clinical course. Ventilatory or oxygenation failure are also indications for intubation.
3) Confirmation of endotracheal tube placement includes methods like direct visualization, auscultation, end-tidal CO2 detection, ultrasound, and chest x-ray. Fiberoptic bronchoscopy is the gold standard.
This document provides guidance on the acute management of trauma patients. It outlines the following key points:
1) Trauma patients require a systematic approach involving preparation, a primary survey to address life threats (airway, breathing, circulation, disability, exposure), and management of specific injuries.
2) The primary survey follows an ABCDE approach and includes airway management, breathing and ventilation assessment, circulation assessment and intravenous access, disability assessment, and full body exposure/examination.
3) Specific guidance is given for managing potential airway issues, tension pneumothorax, chest trauma, hemorrhage, cardiac injuries, and other concerns uncovered during the primary survey. Checklists, guidelines, and multidisciplinary
This document discusses airway management. It covers airway anatomy, assessment of patent and compromised airways, causes of compromise, recognition through listening, looking and feeling, and basic interventions to open the airway including head tilt, chin lift, jaw thrust, suctioning, and use of oropharyngeal and nasopharyngeal airways. It also discusses bag mask ventilation and endotracheal intubation including indications, preparation, technique and confirmation of proper placement.
This document discusses guidelines for extubation and managing risks associated with extubation. It begins by outlining criteria that must be met for safe extubation, such as adequate breathing and hemodynamics. It then describes methods for standard, awake, deep and difficult/high risk extubations. Risks of immediate extubation are outlined. The document provides detailed protocols for managing complications like laryngospasm and laryngeal edema to prevent reintubation. Prophylactic medications, strategies for difficult airways, and criteria for determining pre-extubation airway edema are discussed to ensure extubations are performed safely.
This document provides information on maxillofacial trauma and its anaesthetic management. It begins with the relevant anatomy of the maxilla and important structures that can be damaged. It then describes Le Fort fracture patterns and their clinical features. Imaging studies like CT scans are the standard for evaluation. Special considerations for anaesthesia include securing the airway, which can be difficult due to the injuries, and managing blood loss. Various airway techniques are discussed like fiberoptic intubation, retrograde intubation, or surgical airways if needed. Intraoperative management focuses on invasive monitoring, induced hypotension to reduce bleeding, and muscle relaxation.
This document discusses airway management strategies and techniques. It begins by emphasizing the importance of early airway intervention for trauma patients. It then covers airway anatomy, initial airway assessment including signs of obstruction, supplemental oxygen options, and basic airway adjuncts like oropharyngeal airways. The document details techniques for bag valve mask ventilation and intubation, including indications for rapid sequence intubation. It also discusses surgical airways and adaptations for resource-limited settings that may have limited equipment. A case study is presented on management of a patient with facial trauma and low GCS.
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
The document discusses tracheostomy suctioning and provides information on related anatomy, history, indications, contraindications, hazards, and management of secretions. It details the vagus nerves and their branches, outlines a brief history of suctioning including early studies showing desaturation and cardiac issues, and lists potential hazards like anxiety, increased intracranial pressure, trauma, infection, pneumothorax, hypoxia, and cardiac issues. It emphasizes limiting suction duration and pressure to reduce hypoxia risks.
Lasers in oral and maxillofacial surgery Jeff Zacharia
This document discusses lasers used in oral and maxillofacial surgery. It begins with an introduction to lasers and their properties. It then covers the history of lasers, the components of a laser unit including the active medium and resonator cavity. It classifies lasers based on their active medium and wavelength and discusses their indications for soft and hard tissue procedures. Examples of surgical uses include cleft surgery, TMJ surgery, intraoral lesions, and implantology. Precautions for safe use and the selection of appropriate lasers are also outlined.
This document discusses various induction agents used in general anesthesia. It begins by defining general anesthesia and its key features. It then covers general principles of pharmacology relevant to induction agents, including their action on receptors, plasma protein binding, crossing the blood-brain barrier, and distribution to other tissues. The document classifies common intravenous induction agents and discusses in detail the properties, mechanisms, uses, and adverse effects of thiopental sodium, propofol, and etomidate.
This document discusses dead space management and wound dressings. It defines dead space as any area remaining devoid of tissue after wound closure. Dead space can lead to hematoma formation and increased risk of infection if not properly managed. Methods to eliminate dead space include suturing tissue planes, applying pressure dressings, packing wounds, and using surgical drains. The document then describes different types of drains and their classifications, as well as potential complications. It also discusses wound dressing materials, their purposes and properties.
This document provides information on the Ramus osteotomy procedure, specifically the sagittal split osteotomy (SSO). It discusses the history and evolution of the SSO technique from its early developments to modern procedures. Key steps of the current SSO procedure are outlined, including incision, dissection, identification of anatomical landmarks, and performing the osteotomies along the medial ramus, vertical body, and buccal cortex before splitting the mandible. The SSO allows correction of mandibular deformities by repositioning the proximal and distal segments.
Maxillary canine impaction is a common dental anomaly where the permanent canine tooth fails to erupt into the dental arch. There are several proposed theories for the causes of canine impaction, including lack of guidance from adjacent teeth, insufficient arch length, genetic factors, and systemic conditions. Canine impactions can be classified based on their position, depth, and angulation. Clinical examination and radiographs are used to diagnose impacted canines. Radiographic views like panoramic, periapical, and occlusal films provide information on tooth development and position to determine the appropriate treatment.
The document discusses condylar fractures, including:
- Anatomy of the condyle and temporomandibular joint
- Various classifications of condylar fractures
- Clinical features like swelling, pain, and limited jaw movement
- Diagnosis using radiographs like panoramic x-rays and CT scans
- Treatment approaches like closed or open reduction
- Indications for non-surgical versus surgical management
In 3 sentences it summarizes that the document discusses the anatomy, classifications, diagnosis, and treatment approaches like closed or open reduction for condylar fractures of the temporomandibular joint.
The document provides information on the facial nerve (cranial nerve VII), including its embryology, nuclei, course, branches, landmarks, neurophysiology, causes of damage, and grading systems for facial palsy. It describes the facial nerve's development during gestation, its motor, sensory and parasympathetic functions. Key points along its intra- and extracranial course are identified. Variations, injuries, and resulting functional deficits are also discussed.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
4. INTRODUCTION
• The initial assessment & management of a patient’s injuries must be completed in an
accurate & systematic manner to establish the extent of any injury to vital life support
systems.
• Nearly 25 – 33 % of deaths caused by injury can be prevented when an organized &
systematic approach is used.
5. • Death from trauma has a trimodal distribution
Platinum 10 minutes
• Based on the concept that seriously injured patients should have no more than 10 minutes of scene-
time stabilization by first responders prior to transport for definitive care at a trauma center.
• This is the densest time interval at the scene of the accident, the interval that decides the percentage
of “avoidable deaths” in trauma
6. PRE HOSPITAL TRAUMA CARE
Prehospital care of patients is situation-dependent and centered on stabilization of the
patient and prompt transport to a hospital
It includes low-threshold interventions by emergency personnel such as
• Placement of a cervical collar
• Intubation or oxygen delivery via nasal cannula.
• Administration of intravenous fluid (if hemorrhage or hypotension is suspected)
• Administration of analgesia
• Placement of tourniquets or pressure bandages to control bleeding
8. PRIMARY SURVEY
• The initial assessment is designed to help the Emergency Medical Responder detect all
immediate threats to life.
• Immediate life threats typically involve the patients ABCs, and each is corrected as it is found.
10. AIRWAY
• Airway assessment and restoration of ventilation are critical first steps in management
of a trauma patient.
• Maintenance of airway is dependent on:
1. The absence of any anatomical or mechanical barrier
2. Preservation of the laryngeal reflex.
3. The existence of adequate pulmonary ventilation.
4. The integrity of the respiratory centre.
11. CAUSES OF RESPIRATORY OBSTRUCTIONS RELATED
TO MAXILLOFACIAL TRAUMA
• Inhalation of blood clot, vomitus, saliva, thick mucous or
portions of teeth, bone & dentures.
• Inability to protrude the tongue because of posterior
displacement of the anterior fragment of the mandible
(B/L parasymphysis fracture)
• Occlusion of the oropharynx by the soft palate after
retro-position of the maxilla
13. NON SURGICAL AIRWAY MAINTENANCE
• Position of the patient: Supine with neck extended sideways or patient can be made prone with head
down so collection of blood or saliva in the mouth is not aspirated.
• Oropharyngeal toilet: all blood, saliva, thick mucus or foreign bodies should be cleared from the oral
cavity by digital exploration or by cotton swabs if available.
• Suction
• Anterior traction of tongue.
14. • Chin lift is done by placing the thumb underneath the
chin and lifting forward.
• Jaw thrust is done by placing the long fingers behind
the angle of the mandible and pushing anteriorly and
superiorly although, jaw thrust is preferred if cervical
spine injury is suspected.
15. MECHANICAL AIRWAY ADJUNCTS
Oropharyngeal Airway
• It prevents the tongue from obstructing the glottis, and also
provides an air channel and suction conduit through the mouth.
• It is contraindicated in patients with a gag reflex as it can stimulate
retching, vomiting, or laryngospasm.
16. Nasopharyngeal Airway
• Commonly used with intoxicated or semiconscious victims. They are
also effective when trauma, trismus (i.e., clenched teeth), or other
obstacles (e.g., wiring of the teeth) preclude OPA placement.
• NPAs are contraindicated in victims with basilar skull or facial
fractures, because inadvertent intracranial placement may occur.
17. SURGICAL AIRWAY MAINTENANCE
Indications of tracheostomy
• Airway obstruction above the level of the trachea.
• Need for prolonged intubation.
• More efficient pulmonary hygiene.
• Inability to intubate.
• Adjunct to major head & neck surgery.
21. PERCUTANEOUS TRANSTRACHEAL VENTILATION
• It provides a temporary airway until a formal surgical airway can
be supplied in children younger than 12 years of age where
cricothyrotomy is contraindicated because of the anatomic
difficulty in performing the procedure and risk of stenosis.
• Through this method, alveolar oxygen concentrations can be
maintained for up to 30 to 45 minutes.
22. CRICOTHYROIDOTOMY
Cricothyroidotomy is useful in emergency situations
when attempts to ventilate by bag-valve-mask and
ET tube are unsuccessful.
Indications
• Inability to intubate
• Inability to ventilate
• Inability to maintain SpO2 >90%
• Severe traumatic injury that prevents oral or nasal
tracheal intubation
Contraindications
• Inability to identify landmarks: underlying anatomical
abnormality such as a tumor or severe goiter
• Tracheal transection
• Acute laryngeal disease due to infection or trauma
• Small children under 12 years old
23. 1. Immobilize the larynx and palpate the cricothyroid membrane
2. Vertical incision of the skin & horizontal incision of the CTM
Procedure
24. 3. Insert finger through incision into trachea 4. Tracheal tube insertion
5. Securing the tube
25. C SPINE CONTROL
• Assume cervical spine injury in patients with multisystem
trauma.
• In suspected cases, patient’s head and neck should not be
hyper extended or hyper flexed.
• Intubations performed with the complete cervical collar in
place are associated with greater spinal subluxation
26. CARDINAL SIGNS OF C SPINE INJURY
1. Flaccid extremities
2. Diaphragmatic breathing
3. Ability to flex forearms but unable to extend
4. Facial grimace in response to pain above the clavicle and not below it.
5. Hypotension with warm extremities.
6. Priapism
29. BREATHING
Signs of respiratory distress
• Anxiety
• Tachypnoea more than 25/min.
• Stridor
• Intercostal retraction
• Use of accessory muscles for respiration.
• Hoarseness of voice
• Pallor
• Tachycardia
• Increase in BP
• Signs of hypoxia, hypercapnia, cyanosis
30. TRAUMATIC PNEUMOTHORAX
• Pneumothorax occurs when air enters the in to the
pleural space.
• Air can find its way into the pleural space when there’s
an open injury in the chest wall or a tear or rupture in
the lung tissue, disrupting the pressure that keeps the
lungs inflated.
31. Symptoms of pneumothorax
• Chest ache
• Dyspnea
• Cold sweat
• Chest tightness
• Cyanosis
• Severe tachycardia
Diagnosis of pneumothorax
• PA chest
• CT scan
• Thoracic USG
Normal CXR Pneumothorax CXR
32. TRAUMATIC HEMOTHORAX
• It refers to collection of blood between the pleural
space
• Traumatic hemothorax often causes the pleural
membrane lining the lungs to rupture causing it to spill
blood into the pleural space.
• Hemothorax often occurs with pneumothorax.
33. Symptoms of hemothorax
• Chest ache
• Cold clammy skin
• Tachycardia
• Low BP
• Shallow breathing
• anxiety
Diagnosis of hemothorax
• PA chest
• CT scan
• Thoracic USG
34. FLAIL CHEST
• Flail chest is an injury that occurs typically
following a blunt trauma to the chest.
• When three or more ribs in a row have multiple
fractures within each rib, it can cause a part of
the chest wall to become separated and out of
sync from the rest of the chest wall.
36. Imaging
• Radiographs
• CT
Treatment
• Observation is advised when there is no respiratory
compromise or when then there is not more than 3
fractured segments.
• ORIF is advised when there is respiratory compromise, open
rib fractures or when there is more than 3 flail segments of
the ribs
37. MANAGEMENT OF BREATHING
• If not breathing adequately, begin BAG-VALVE-MASK-VENTILATION
• If breathing fast or hypoxia, administer Oxygen to achieve oxygen saturations between 94-
98%.
• If wheezing, administer 5mg salbutamol IV
• If concern for tension pneumothorax, perform NEEDLE DECOMPRESSION and plan for chest
tube insertion
39. CIRCULATION & HEMORRHAGE CONTROL
• Once the airway and breathing are stabilized, perform an initial evaluation of the patient's
circulatory status by palpating central pulses. If a carotid or femoral pulse is verified and no
obvious exsanguinating external injury is present, circulation may momentarily be assumed to
be intact.
• In almost all medical and surgical emergencies, consider hypovolemia to be the primary cause
of shock, until proven otherwise.
40. ASSESSMENT OF CIRCULATION
Pulse
• Absent or diminished peripheral pulse is a sign of shock
• Tachycardia - is a sign of shock, as well as of fear and anxiety.
• Bradycardia - is a sign of imminent death.
Capillary Refill
• A prolonged CRT suggests poor peripheral perfusion.
• Capillary refill is prolonged in shock, but is also prolonged by pain, fever and environmental
factors, such as cold.
41. Skin color/temperature
• Mottling/pallor and cyanosis of the skin indicate poor perfusion due to either a
sympathetic response to low cardiac output or to pain, fear or cold.
Blood Pressure
• Hypotension is a late sign of shock, and imminent death.
42. Other signs of circulatory inadequacy
• Respiratory distress or failure
• Agitation, confusion or decreased conscious level
• Rapid, deep breathing may be a sign of metabolic acidosis
• Decreased urinary output.
43. CARDIOPULMONARY RESUSCITATION
If the health care provider is unable to feel the carotid pulse in 10 seconds, the
provider should begin chest compressions and rescue breaths.
44. • CPR involves chest compressions at least 5cms (2 inches) deep
at the rate of at least 100 per minute in an effort to create
artificial circulation by manually pumping blood through heart.
• In addition , the rescuer may provide breathe by either
exhaling into patient’s mouth or nose or utilizing a device
thatpushes air into subject’s lungs (artificialventilation)
45. Universal compression : Ventilation ratio
• For adults 30 : 2 recommended
• For children 15 : 2 recommended
Recommended depth of compression
• In Adults and children 5 cm (2 inches)
• In Infants 4 cm (1.5 inches)
Hand placement
• In Adults rescuer should use both hands
• In Children they should use one hand.
• In infants 2 fingers (index and middle finger)
46. HYPOVOLEMIC SHOCK
• Shock has been defined as a state of acute energy failure that stems from a
decrease in adenosine triphosphate production, and subsequent failure to meet the
metabolic demands of the body leading to anaerobic metabolism and cytotoxic
metabolite accumulation
• It is the most common type of shock seen in trauma patients and occurs as a result
of decreased intravascular volume secondary to acute blood loss.
47. Pathophysiology of shock
Deprivation of O2
Anaerobic metabolism
Accumulation of lactic acid (metabolic acidosis)
When glucose is exhausted (anaerobic also stops)
Failure of Na/K pumps
Activates the intracellular lysosomes
Which activates release of autodigestive enzymes
Cell lysis
48. CLASSIFICATION OF HAEMORRHAGIC SHOCK BY THE ‘AMERICAN
COLLEGE OF SURGEONS COMMITTEE ON TRAUMA’
Class I: Acute blood loss < 15% of total blood
volume
• Pulse and respirations increase
• BP may not be significantly affected
Class II: Acute blood loss 20-25% of total blood
volume
• Increased pulse & respirations
• Decreased blood pressure
• No change in urine output
Class III: Blood loss of 30-40% of total blood volume
◦ Increased pulse and respirations
◦ Decreased blood pressure
◦ Decreased urine output
Class IV: Blood loss of 40-50% of total blood volume
◦ Lack of vital signs
◦ Poor mental status
49. MANAGEMENT OF SHOCK
Fluid replacement
• Initial resuscitation should consist of bolus of 2 L of warmed crystalloid solution. 2-3 times of blood
volume lost must be replaced with crystalloids.
• After initial resuscitation, colloids are preferred as these restore intravascular volume. 1 – 1.5 times
blood lost can be replaced with colloids.
• Blood transfusion: if Hb < 8. If massive transfusion is required [>10 units of packed red blood cell
(PRBCs)], attempts should be made at maintaining a 1:1 ratio of PRBCs and FFP
50. • Supportive care: nasal oxygenation and ventilator support will be necessary.
• Catheterization has to be done to measure urine output (30 – 50 mL/hr. or 0.5 mL/kg/hour should be
maintained)
• Correction of acid base balance by administration of 8.4% Sodium bicarbonate IV (normal S. lactate
levels: 0.5 – 1 mmol/L )
• Administration of 500 – 1000 mg hydrocortisone to improve perfusion, reduce capillary leakage and
systemic inflammatory effects.
• Administration of IV morphine 4mg for pain control.
• Use of activated C protein to prevent the release of inflammatory mediators
• Hemodialysis maybe necessary when kidneys are not functioning
51. LOCAL METHODS TO CONTROL BLEEDING
• local pressure (biting on gauze or tea bags)
• site packing [gelatin sponges (Gelfoam); absorbable oxycellulose (Surgicel);
microcrystalline collagen (Avitene)]
• additional suturing
• electrocautery
• topical thrombin powder
• tranexamic acid mouth rinse 5%
• cold water rinse
• aminocaproic acid mouth rinse 5% (hold 10ml in mouth for 2 minutes an
hour pre-procedure then repeat q2h for 6-10 doses prn)
52. ANTERIOR NASAL PACKING
• Epistaxis is defined as acute hemorrhage from the nostril, nasal
cavity, or nasopharynx.
• Nasal packing is done if the bleeding cannot be controlled even after
application of pressure on the nostrils.
• Packing is done using ribbon gauze soaked with liquid paraffin.
• It can be done either in vertical or horizontal layers.
• vasoconstriction can be attempted with topical application of 4
percent cocaine solution or an oxymetazoline or phenylephrine
solution
53. POSTERIOR NASAL PACKING
• Posterior bleeding is much less common than anterior bleeding
Steps in packing
1. After adequate anesthesia has been obtained, a catheter is passed through the affected
nostril and through the nasopharynx, and drawn out the mouth with the aid of ring forceps
54. 2. A gauze pack is secured to the end of the catheter using umbilical tape or suture material,
with long tails left to protrude from the mouth.
3. The gauze pack is guided through the mouth and around the soft palate using a combination of careful
traction on the catheter and pushing with a gloved finger
55. 4. The gauze pack should come to rest in the posterior nasal cavity. It is secured in position by
maintaining tension on the catheter with a padded clamp or firm gauze roll placed anterior to
the nostril. The ties protruding from the mouth, which will be used to remove the pack, are
taped to the patient’s cheek.
57. DISABILITY
• After the establishment of the airway & stabilization of the cardiovascular system,
neurological examination is done to assess the level of consciousness
• To assess the patient’s level of consciousness, the Glasgow Coma Scale ( Teasdale &
Jennett, 1974) can be used.
59. A V P U SCALE
• A - ALERT. The alert patient is will be awake, responsive, oriented, and talking
• V - VERBAL. This is a patient who appears to be unresponsive at first, but will
respond to a loud verbal stimulus.
• P - PAINFUL. If the patient does not respond to verbal stimuli, he may respond
to painful stimuli such a sternal (breastbone) rub or a gentle pinch to the shoulder
• U - UNRESPONSIVE. If the patient does not respond to either painful or
verbal stimuli
60. SIMPLIFIED MOTOR SCORE (SMS)
Simplifies assessment of head trauma patients compared to the GCS.
The Simplified Motor Score (SMS) is defined as:
• Obeys commands = 2
• Localizes to pain = 1
• Withdrawals to pain or worse = 0.
Patients with a SMS of <2 indicates significant traumatic brain injury and prompt
evaluation of the head using CT scans should be done.
61. GRADY COMA SCALE
• GRADE I: Patient is slightly confused
• GRADE II: Patient requires a light pain stimulus for appropriate arousal
• GRADE III: Patient is comatose but will ward off deep painful stimulus such as sternal
pressure or nipple twist.
• GRADE IV: Patient reacts inappropriately with either decorticate or decerebrate posturing
to deep painful stimuli.
• GRADE V: Patient remains flaccid when similarly stimulated.
62. INJURY SEVERITY SCORE
• Based on anatomic criteria
• It considers 9 variables
• Each variable has a score from 0 – 6
• It is calculated against a total score of 75
• If the score > 15: mortality of 10 %
ISS score = (sum of 3 highest variables)2
= A2 + B2 + C2
63. PUPILLARY LIGHT REFLEX
• The pupillary light reflex is elicited by shining a bright light into the eye.
This triggers a complex neural reflex that normally leads to pupillary
constriction in both the ipsilateral eye (direct response) and the
contralateral eye (consensual response)
• When an intracranial hematoma expands, the medial edge of the uncus is
pushed over the lateral edge of the tentorium and the ipsilateral third
nerve is compressed, compromising the efferent parasympathetic
pathways to the pupil and resulting in dilation & unresponsiveness to a
light stimuli.
65. EXPOSURE
• Remove all clothing to halt progression of burn from
melted synthetic compounds or chemicals and to assess
the full extent of body surface involvement in the initial
examination. Irrigate injuries with water or saline to
remove harmful residues.
• Avoid hypothermia by limiting exposure of the body, and
by warming all ongoing fluids.
67. SECONDARY SURVEY
It does not begin until the primary survey & resuscitative efforts are completed & well
established.
It involves
• Head to toe evaluation
• history & physical examination
• Reassessment of all vital signs
70. HEAD & SKULL EXAMINATION
• Examine & palpate the head for scalp hematoma, skull
depression, or lacerations.
• No nasogastric tube (NG) should be inserted if there is facial
trauma or evidence of basilar skull fracture.
• Ears should be evaluated for hemotympanum or retro-auricular
ecchymosis (Battle's sign)
• Presence of blood or clear drainage from the ear canal indicates
basilar skull fracture with cerebrospinal (CSF) leak.
72. ORAL & MAXILLOFACIAL EXAMINATION
Extraoral examination
• The length, breadth & depth of the soft tissue wound should be measured
and documented.
• Inspect the nose & ear for presence of bleeding or CSF leak
• Periorbital edema & ecchymosis , subconjunctival hemorrhage can be
noticed.
• If the patient is conscious, the vision is tested in each eye by asking the
patient to follow the clinician’s finger with eyes, without moving his head.
74. NEUROLOGICAL EXAMINATION
Facial nerve
• If conscious, we can ask the patient to use the muscles of facial expression.
• If unconscious, nerve stimulators can be used.
Infraorbital nerve
• This nerve may be injured as a result of blow out fractures that involve the
inferior orbital fissure.
Olfactory nerve
• Occurs as a result of fracture of the mid – face that involves the cribriform plate
of the ethmoid.
• Anosmia resulting from this is usually permanent.
75. Oculomotor nerve
• presence of dilated pupil usually occurs from intracranial compression due
to increasing intracranial pressure.
Abducent nerve
• Common in patients who suffered deceleration injuries.
• Results in lateral rectus muscle dysfunction on lateral gaze.
Optic nerve
• The patient can present with pain, loss of vision, visual field loss, loss of
color vision.
• Early identification may salvage the patients vision
76. Intraoral examination
• Oral & Pharyngeal tissues should evaluated for lacerations &
penetrating injuries.
• Orifices of Stenson’s duct & Wharton’s duct must be evaluated
for patency & salivary flow.
• Sublingual hematoma is the most common indicative of
mandibular fracture.
• Antero-posterior laceration & ecchymosis of the palate
indicates palatal fracture
77. • Bilateral condylar fractures are often characterized by
limited mouth opening, anterior open bite & preauricular
pain.
• After 48 hours, pain, swelling & induration may be
indicative of infection associated with mandibular
fractures .
• Reduced mouth opening < 35 mm or deviation of 6 mm
indicates presence of a mechanical problem secondary to
mandibular fractures
78. NEUROLOGICAL EXAMINATION
Inferior alveolar nerve
• May result in lip anesthesia on the affected side which could be permanent.
Lingual nerve
• Less common to be injured.
• Results in anesthesia or paresthesia of the anterior two thirds of tongue.
• If chorda tympani is also damaged, it can result in altered taste sensation
79. RADIOGRAPHS IN MAXILLOFACIAL TRAUMA
For middle third of face
• 15⁰ to 30⁰ occipitomental view
• PA view (Walter’s position)
• Lateral skull view
• Cranial PA view
80. For ZMC fracture
• Occipitomenton view 15⁰ & 30⁰
• PA view ( Walter’s position)
• Submentovertex view
• CT of the orbit
For mandible
• OPG
• Lateral oblique view
• PA view
• Towne’s view for condylar fractures
• Occlusal view
81. NECK EXAMINATION
Inspect for
• tracheal deviation
• subcutaneous emphysema
• laryngeal tenderness
• distension of the neck veins
• carotid pulsation and the presence of a hematoma
Palpate for
• Posterior cervical spine for tenderness along the midline or paraspinal tissues
83. CHEST EXAMINATION
Inspect for
• bruising (from seat-belts)
• asymmetric or paradoxical chest wall movement
• penetrating wounds
Palpate for
• clavicular and rib tenderness
Auscultate for
• the lung fields
• heart sounds.
84. ABDOMEN EXAMINATION
Inspect for
• Seat-belt bruising / handle-bar injuries
• Distension
• Blood at the urinary meatus / introitus
Palpate for
• Tenderness over the liver, spleen, kidneys and bladder
auscultate for
• Bowel sounds.
85. PELVIS EXAMINATION
Inspect for
• grazes & bruising over the iliac crest
• scrotal, labial or perineal hematoma,
swelling or ecchymosis
• External rotation of one or both extremities
• Limb length discrepancy
86. BACK EXAMINATION
• Can be done during log rolling
Inspect the entire length of the back and buttocks.
Palpate for
• the spine for tenderness
• the scapulae and sacroiliac joints for tenderness
88. TRIAGE
• In mass casualty situations, triage is used to decide who is
most urgently in need of care and whose injuries are less
severe and can wait.
• It is mainly used in natural disasters, major accidents, terrorist
attacks or wars
• It involves a color coding scheme using red, yellow, green,
white, and black tags.
89. RED TAG - (IMMEDIATE)
Used to label those who cannot survive without immediate treatment but who have a
chance of survival.
• Obstructed airway
• SPO2 < 80 % & RR > 35 or < 8 cycles
• HR > 130 bpm
• BP < 80 mmHg
• GCS < 8
90. YELLOW TAGS - (60 MINUTES)
Patient’s condition is stable and are not in immediate danger of death.
• SPO2: 90 – 94 % & RR: 25 – 35 cycles
• HR: 110 – 130 bpm or less than 50 bpm
• GCS: 14
Who will need medical care at some point, after more critical injuries have been treated
• SPO2 > 95%
• HR: 50 – 110 bpm
• GCS: 15
GREEN TAG - (180 MINUTES)
91. ADJUNCTS TO PRIMARY SURVEY & RESUSCITATION
Diagnostic studies:
• Chest
• Pelvis
• C spine
• USG FAST
Urinary or gastric catheters
Monitoring
• ABG analysis & ventilatory rate
• End tidal carbon dioxide
• EKG
• Pulse oximetry
• Blood pressure
92. FOCUSED ASSESSMENT WITH SONOGRAPHY IN
TRAUMA (FAST)
It is a rapid bedside ultrasound examination performed as a screening test for blood
around the heart or abdominal organs (hemoperitoneum) after trauma.
It is rapid, sensitive & cost effective and eliminates unwanted CTs.
The four classic areas that are examined for free fluid are the
• perihepatic space
• perisplenic space
• pericardium
• Pelvis
93. CONCLUSION
Trauma care is governed by two underlying principles: early definitive management and
a continuum of treatment from the time of injury to the return to the activities of daily
life. Despite considerable advances in treatment in the last 20 years, trauma continues
to be the main cause of disability and death for people under the age of 40 years.
Therefore, A comprehensive approach addressing the factors before, during and after
the event is essential to improve the quality of life.
This is a military concept used to prevent battlefield fatalities within the first few minutes post injury
Ventilatory excursion: movement of thoracic diaphragm while breathing
In order to prevent the tongue from obstructing the airway,
This is followed by the placement of a nasopharyngeal or oropharyngeal airway
The oropharyngeal airway is an S-shaped device
The nasopharyngeal airway (NPA) is an uncuffed trumpet-like tube which is inserted through the nose
In emergency, we can use a 12 – 14 gauge over the needle catheter through cricothyroid membrane or into trachea
Stridor is an abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, glottis, subglottis, or trachea.
The intercostal muscles are the muscles between the ribs. During breathing, these muscles normally tighten and pull the rib cage up. Your chest expands and the lungs fill with air.
Intercostal retractions are due to reduced air pressure inside your chest. This can happen if the upper airway (trachea) or small airways of the lungs (bronchioles) become partially blocked. As a result, the intercostal muscles are sucked inward, between the ribs, when you breathe. This is a sign of airway obstruction. Any diseases or condition that causes a blockage in the airway will cause intercostal retractions.
shortness of breath,
rapid breathing, and
a fast heart rate.
Severe symptoms include:
The inability to communicate
Confusion
Possible coma or death
Other associated symptoms also may be present.
A massive hemothorax (>1 L) can lead to shock
MGT: a chest tube is inserted to drain the blood. However, if there is more than 500 mL of blood Thoracotomy has to be done to stop the bleed.
If not breathing adequately (too slow or too shallow)
In case of hypersensitivity, administer 0.5 mL of 1:1000 adrenaline IM
Treat the cause, E.g. Arrest hemorrhage
https://www.nursingtimes.net/clinical-archive/cardiovascular-clinical-archive/advantages-and-disadvantages-of-colloid-and-crystalloid-fluids-09-03-2004/
This is followed by administration of antibiotics to prevent maxillary sinusitis & toxic shock syndrome.
A person is assessed against the criteria of the scale, and the resulting points give a person's score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used, modified or revised scale).
Generally, brain injury is classified as:
Severe, GCS < 8–9
Moderate, GCS 8 or 9–12
Minor, GCS ≥ 13
Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the GCS.
The AVPU scale has four possible outcomes for recording (as opposed to the 13 possible outcomes on the Glasgow Coma Scale). The assessor should always work from best (A) to worst (U). The four possible outcomes are
a scale used to rate level of consciousness, with five grades corresponding to confusion
This mnemonic device can be used for obtaining a quick, focused history:
such as exposure to chemicals, toxins or radiation
A. Supraorbital ridge. B. Infraorbital rim C. lateral margin of orbit. D. Zygomatic bone & arch E. nasal bones F. TMJ D. zygomatic buttress E. mid face mobility
Should be examined prior to the injection of LA or GA