4. TRAUMA SCENARIO
MALE PATIENT 34YEARS OLD COMINGTO ER
AFTER ROAD TRAFFIC ACCIDENT:
HOARSNESSOFVOICE
BP 90/50
RR 30
PULSE 130
ABRASION ON LT CHESY
WHAT DOYOU DO?
8. Breathing / ventilation / oxygenation
Circulation with hemorrhage control
Disability
Expose / Environment / body temp.
Primary Survey
Airway with c-spine protection
9. Airway
Patent and clear
If not open air way :chin lift , jaw trust
Use adjunct to airway:
Oropharyngeal , nasopharyngeal , LMA,ET
GIVE HIGH FLOW O2TO ALLTRAUMA
PATIENT
IF EIGHT INTUBATE
A
10. Sequence of air way maneuvers
chin lift
Jaw thrust
finger sweep
suction
Oropharyngeal/ orotrachial tube
Cricothyroidotomy
Tracheostomy
11. C- SPINE PROTECTION
INLINE
IMMBOLIZATION
NECK COLAR
HEAD LOCK
HARD BOARD
bellets
12. BREATHING
CHECK:
CHEST MOVEMENT
EQUALITY IN BOTH SIDE
AIR ENTERY
PERCUSSION
O2 SATURATION
RESPIRATORY RATE
B
13. Our task is to identify
Five life threatening thoracic conditions:
Tension Pneumothorax
Massive Pneumothorax
Open pneumothorax
Flail segment
Cardiac tamponade
14. Abnormal Findings
Un equality of chest movement
Hyper resonance on percussion
Decrease air entry
Tachypenic
Pneumo thorax
Needle decompression & chest tube
15.
16. Abnormal Findings
Un equality of chest movement
Hyper resonance on percussion
Decrease air entry ,tachypenic
Deviated trachea ,congested neck vein
Tension Pneumo thorax
Needle decompression & chest tube
17.
18.
19. Abnormal Findings
Un equality of chest movement
Dullness on percussion
Decrease air entry
Tachypenic
heamothorax
chest tube
22. Abnormal Findings
Un equality of chest movement
Dullness on percussion
Normal air entry ,muffled heart sounds
Tachypenic, congested neck veins
Cardiac tamponade
pericardiocentesis
23. (almost always seen with a penetrating
wound)
Beck’s triad:
Hypotension
distended neck veins
Muffled heart sounds
Pulsus paradoxus
27. Skills in B
Needle de compression
Chest tube (thoracostomy)
pericardiocentesis
Endo tracheal intubation
28. circulation
Check :
Bp
Pulse
Capillary refill
Search for External bleeding
Search for Internal bleeding
2 wide bore cannula
Blood sample for ABO compatibility,
creatinine,urea,ABG
GIVE 2 liters warmed crystalloid
C
29. Tachycardia in a cold patient indicates shock
Causes of shock following injury:
Hypovolemic
Cardiogenic
Neurogenic
Septic
30. Adults- 2 lit of Ringer lact soln as initial fluid
challenge
Children- 20mg/kg of body wt
Response to initial fluid challenge:
Immediate & sustained return of vital signs.
Transient response with later deterioration
No improvement.
31. Urine output –
0.5ml/kg/hr in adults
1ml/kg/hr in children
2ml/kg/hr in infants
32. Skills in C
Direct compression in
site of external bleeding
Splint of long bone
fractures
FAST( E- FAST)
X-ray chest , pelvis
Consult surgeon
33. Disability
Determine Glasgow
coma scale
Check pupil for
(equality-reactivity)
Signs of lateralization
Neurological
assessment
D
A.-Alert
V.-Responds to
Voice
P.-Responds to
Pain
U.-Unresponsive
Pupil.-Size and
reaction
50. PELVIS
Clinical assessment of stability
X-ray
stabilize pelvis with fixator/clamps –pelvic
binder
If urethral injury is suspected
high up prostate in PR
blood in meatus
perineal haematoma
53. Radiography:The "trauma triple" is a portable
cervical spine, anteroposterior chest, and
anteroposterior pelvis radiographs.
Laboratory studies: Obtain a complete blood cell
count and chemistry, including a sodium level,
potassium level, renal function assessment,
urinalysis, urinary toxicology screen, and a beta-
human chorionic gonadotropin value in all females
of childbearing age.
ADJUCANTS
54. Blood preparations: Order a type and screen, and
consider cross-matching 2-4 units of RBCs,
depending on the severity of the trauma and
shock.
Urinary and gastric catheterization
Temperature, ECG and oxygen saturation
monitoring
55.
56. TRAUMA SCENARIO
MALE PATIENT 34YEARS OLD COMINGTO ER
AFTER ROAD TRAFFIC ACCIDENT:
HOARSNESSOFVOICE
BP 90/50
RR 30
PULSE 130
ABRASION ON LT CHESY
WHATYOU DO?
60. A.R.D.S.
Tachypnoea
Dyspnoea
Bilateral infiltrates in C XR
Treated with mechanical ventilation
CPAP with or without PEEP
Glucocorticoids
Inhaled nitric oxide
61. Fat embolism
Around 72 hours
Tachycardia
Tachypnoea
Dyspnoea
Chest pain
Petechial haemorrhage
Treated with ----- mechanical ventilation
------anticoagulants
------fixation of fractures
62. Disseminated intravascular coagulation
Follows severe blood loss and sepsis
Restlessness , confusion,neurological
dysfunction,skin infercation,oligurea
Excessive bleeding
Prolonged PT,PTT,TT,hypofibrinogenemia
Treatment– prevention and early correction and shock
63. Crush syndrome
When a limb remains compressed for many hours
Compartment syndrome and further ischaemia
Cardiac arrest due to metabolic changes in blood
Renal failure
Treatment
Prevention-ensure high urine flow during extrication
IV Crystalloids,Forced mannitol alkaline diuresis
Fasciotomy and excision of devitalised muscles
Amputation
64. M.S.O.F.
Progressive and sequential dysfunction of physiological
systems
Hypermetabolic state
It is invariably preceded by a condition known as
Systemic Inflammatory Response Syndrome (SIRS)
Characterised by two or more of the following
Temperature >38º C or < 36ºC
Tachycardia >90 /min
Respiratory rate >20/min
WBC count >12,000/cmm or <4,000/cmm
65. M.S.O.F.
Treatment : Key word is PREVENTION
Prompt stabilisation of fracture
Treatment of shock
Prevention of hypoxia
Excision of all dirty and dead tissue
Early diagnosis and treatment of infection
Nutritional support
66. Face book
Face book group:
Egyptian Ghanian healthcare alliance
For:
friendships
Photos
Videos
Sharing knowledge
Any help from EGYPT