This document provides an overview of primary management of trauma. It discusses the initial assessment process known as ABCDE (Airway, Breathing, Circulation, Disability, Exposure) and secondary survey that are part of the Advanced Trauma Life Support (ATLS) protocol. The primary goals are to identify life-threatening injuries, stabilize the patient, and determine appropriate definitive care. Common childhood injuries include falls, assaults, and road traffic accidents. Initial management focuses on airway control, breathing, hemorrhage control, and neurological status before fully examining the patient and developing a treatment plan.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
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.
neurosurgery is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
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
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
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.
neurosurgery is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
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
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
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4. What is Trauma ?
Trauma is the study of medical problems associated
with physical injury.
There are a variety of forces that can lead to
injury,including thermal,ionizing radiation and
chemical.However in most injuries is mechanical.
5. Epidemiology
Trauma is the most common cause of death in children and young
adult between the age of 1 to 44 years worldwide.
In addition to mortality,injuries have the potential to cause many
other long-term health problems with serious consequences for
individuals,families,communities and health-care systems.
Worldwide,childhood injuries are a growing problem.Childhood
injuries are most common between 5-10 years of age group.
Every Year 8,75,000 child die globally.
6. Mechanisms of Trauma :
Trauma can be classified in type by causation and by
effect-
* Blunt trauma e.g. RTA
* penetrating trauma e.g. knife
* Blast injuries e.g. bomb
* Crush injuries e.g. building collapse
* Tharmal injuries.
* Chemical injuries.
7. Cause of childhood trauma:
* Fall from heights (62%)
* At play ground
* Assault
* road traffic accidents.
9. Trauma team:
Composition:
* Doctors from the emergency department.
* Anaesthetics and/ critical care doctor.
* Orthopaedics surgeon.
* General/Paediatric surgeon.
* Radiology & haematology doctor.
10. PRIORITY:
Highest priority:
* Cervical spine injury.
* Respiratory impairment.
* Cardiovascular insufficiency.
* Severe external hemorrhage.
* Intraperitoneal injuries.
* Brains and spinal cord injuries.
* Severe burns or extensive soft tissue injuries.
11. Priority:
Low priority:
* peripheral vascular,nerve and tendon injuries.
* Fractures and dislocation.
* Minor trauma etc.
12. Initial Assessment & management :
Objectives:
* Identify the correct sequence of priorites in assessing the
polytrauma patient.
* Apply principles of advanced trauma life support (ATLS)
philosophy.
* Apply guidelines & technique of resuscitative & definitive care
15. Pre hospital phase:
Airway maintenance
Control of external bleeding & shock
Immobilization
Notify receiving hospital
Send to the closest,appropriate facilities.
In general, children fare worse than adults in the out of hospital phase of
resuscitation.The injury adjusted death rate for children is twice that of adults.
16. In hospital phase
Team assembly
Proper trauma care facilities should be available e.g.
* proper airway equipment
* I/V fluids
* monitoring facilities
* lab & imaging facilities
* facilities for taking universal precautions etc.
17. Triage :
Triage means to short and allocation of the injured patients
into certain categories on basis of priority & urgent need of
treatment for saving maximum live.
18. Type of triage:
Two types:
* Triage sieve : Triage sieve mean to separate the dead and
walking from injured patients.
* Triage short :Triage short mean to categorize the injured
patients in different categories.
19. Triage categories:
Priority Colour Medical need Clinical status Example
First(I) Red Immediate Critical,but likely to survive
if treatment given early
Severe facial trauma,tension
pneumothorax,flial
chest,haemothorax,profuse
ext. bleeding,intra
abdominal heg. Etc.
Second(II) Yellow Urgent Critical,but likely to survive
if treatment given within
hours.
Compound fracture,
degloving injuries,ruptures
abdominal viscus,spinal
injuries etc.
Third(III) Green Non-urgent Stable,likely to survive if
treatment is delayed for
hours to days
Simple
fractures,sprains,minor
lacerations.
Last(0) Black Unsalvageable Not breathing,pulseless,so
severely injured that no
medical care is likely to
help.
Severe brain damage,very
extensive burns,major
disruption/loss of chest or
abdominal wall structures.
20. Implementation of triage:
Triage should be implemented in the
* Field of accident.
* Emergency department.
* Radiology department.
21. Advanced trauma life support :
Dr. james Kenneth Styner,programmed ATLS in 1976.
ATLS is the most comprehensive method of assessment and
management of an injured child.
22. Components of ATLS:
Primary survey with simultaneous resuscitstion : identify and
treat what is killing the patients.
Secondary survey: proceed to identify all other injuries.
Definitive care: develop a definitive management plan.
23. Primary survey and resuscitstion :
The initial management of the traumatized pt must first
consists of a rapid primary evaluation and resuscitation of
vital functions.
In primary survey clinical evaluation of the child is done.
The primary survey comprise the fundamental principles of
the ATLS system,the “ABCDE” of trauma care.
24. ABCD of trauma care:
A- Airway with cervical spine protection.
B- Breathing and ventilation.
C- Circulation with haemorrhage control.
D- Disability: neurological status.
E- Exposure: completely undress the patient and assess for
other injury.
25. Airway & cervical spine:
Assessment of –
* Patency of airway
* Any airway obstruction.
* Check for trachea,larynx and faciomaxillary injury.
* check for vocal response.
Management:
* Jaw thrust and chin lift, if required.
* Ensure cervical spine immobilization by neck brace,sand bag .
* Clear mouth and air way if FB,blood,vomitus & secretion.
* If Glasgow coma score <8 ,consider definitive air way.
26. Breathing & ventilation :
Assessment of the patient –
* Inspect/percuss & auscultate chest
* Cyanosis
* Rate and depth of respiration.
* Any abnormality in the chest wall movement
* Check for pneumothorax,haemothorax,# rib etc.
Management-
* Give 100% oxygen or high flow.
* Insert chest drain for pneumothorax/haemothorax.
* Major vessels with in the chest needs to controlled.
27.
28. Circulation & control of bleeding:
Assessment-
* Identify the site of bleeding
* Check pulse and blood pressure,temperature
Management-
* Secure two large bore cannula,take blood and fluid
resuscitation.
* Examine for evidence of blood loss and treat accordingly
.
29. Disability :
Rapid assessment of the patient`s level of consciousness by
GCS. Or by
Assessment of pupillary size and reaction.
Fracture of the limbs is the most common cause of either
temporary or permanent disability.So limb immobilization by
plaster cast,pain management and blood transfusion is
necessary.
30. Disability:
Assess mental state using the AVPU or Paediatric Glasgow
coma scale.
AVPU :
* A- Alert child
* V- Response to voice
* P- Response to pain
* U- unconscious.
31. Disability:
Paediatric Glasgow coma Scale:
Score Eye opening verbal Grimace response Motor response
1 None None None None
2 To pain Occational
whimper/moan
Mild to pain Extension to pain
3 To voice Inappropriate cry Vigorous to pain Flexes to pain
4 Spontaneous Decrease
verbal/irritable cry
Less than usual face
movement
withdraws
5 Allert babbles/words
as normal
Spontaneous face
movement
Localises to pain
6 Obeys commands
32. Exposure:
Complete undress the patient,baby should be covered by
warm blanket to prevent hypothermia.
Examine the baby from front and back using a careful
controlled log roll.
33. Adjucents to the primary survey:
Blood tests- CBC
ECG,ABG,Pulse oximetry.
Two wide bore cannulae for I/V fluids.
Urinary and gastric catheters.
Radiographs of cervical spine,chest and pelvis.
34. Secondary survey :
The secondary survey dose not begin until after the primary survey has
been completed.
The purpose of secondary survey is to identify all others injuries and
perform head to toe examination
Reassessment of vitals.
Review of patient`s history-
* A- Allergy.
* M- Medication
* P- Past medical history.
* L- Last meal.
35. Continue….
Specific visceral injuries are common in children-
* Duodenal haematoma
* Pancreatic injury
* Small bowel perforation
* Mesenteric injuries
* Bladder injury
36. Definitive care :
* Definitive treatment plan according to cause
* Live saving surgery may need .
