This document discusses the management of polytraumatized patients presenting to the emergency department. It defines polytrauma as two or more significant injuries to two or more organ systems. The management involves a multidisciplinary team performing a primary survey to address life threats, secondary survey to identify all injuries, and definitive treatment tailored to the patient's condition. Complications can include shock, sepsis, multiple organ dysfunction syndrome, and death if not properly managed. Special considerations are given to polytrauma in children, elderly, and pregnant patients.
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
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
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
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.
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
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.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
Guidelines on the use of plaster of paris in fracture management. Quite useful for orthopedic residents, GPs, plaster techs, orthopedic care nurses, rehabilitation physicians, physiotherapists
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
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.
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
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.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
Principles of Management of the multiply injured patientCHRIS ALUMONA
The multiply injured or polytraumatised patient is at a greater risk of morbidity and mortality than patients with isolated injuries. This risk is greater than the sum of the risks of their individual injuries. A high index of suspicion is needed to recognise immediately life threatening injuries and promptly address them. The principles of management is captured with the ATLS protocol and every trauma surgeon should be conversant with this indispensable tool.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
Guidelines on the use of plaster of paris in fracture management. Quite useful for orthopedic residents, GPs, plaster techs, orthopedic care nurses, rehabilitation physicians, physiotherapists
Informest Consulting - Gli strumenti finanziari a supporto dell'internazional...Romiri Data Management srl
Informest Consulting - Gli strumenti finanziari a supporto dell'internazionalizzazione di impresa
Esportare il Made in Italy - Mestre, 26 settembre 2013
Esportare il Made in Italy - Intro
Supporto all'internazionalizzazione. Aprire nuovi mercati in Sud Africa - weBiz
Opportunità dei Paesi del Maghreb e Turchia - Sergio Battalliard
Strumenti per vendere all'estero - Romiri Data Management
Strumenti operativi per vendere nei Paesi del Golfo - Romiri srl (JLT Branch)
The perfect media centre, where you can load and discard your DVDs, Blue-ray disc, load downloaded media... Movies, music & photos. You can simultaneously listen to a concert in the quietness of your lounge, whilst the children enjoy a cartoon in the playroom, or easily show a slideshow to your friends. This is true audiovisual ubiquity !This amazing offering delivers four(4) audiovisual universes and thanks to the hand movement sensitive gyroscopic remote control you can just point, wave and select... or use touch sensitive devices such as touch tablets or smart-phones as easily! Further, there are no media source restrictions. See the "Utrema Home Centre" Here
Ibiza Holidays at Travel Club. Our all inclusive and last minute cheap package holiday deals to Ibiza are tailor made to suit all budget requirements. Visit : http://www.travelclub.co.uk/
INITIAL ASSESSMENT AND INTENSIVE CARE IN TRAUMA.pptxMahima Shanker
CONTENTS-
INTRODUCTION
TRIMODAL DISTRIBUTION
GOLDEN HOUR
PREPARATION
TRIAGE
BASIC LIFE SUPPORT
A B C D E
SECONDARY SURVEY
DIAGNOSIS OF MAXILLOFACIAL INJURIES
A summarised guide on these often frequently carried out proceduresv - arthrocentesis & arthrotomy. Quite useful for orthopaedic residents, GPs and med students
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. THE MANAGEMENT OF A
POLYTRAUMATISED PATIENT
PRESENTING AT THE EMERGENCY
DEPARTMENT
DR BASSEY A E
DEPARTMENT OF ORTHOPAEDICS
2.
3. OUTLINE
• Introduction
• Definitions
• Epidemiology
• Statement of importance
• Aetiology
• Mechanisms of injury
• Management
• Primary survey and resuscitation
• Secondary survey
• Definitive treatment
• Complications
• Early
• Late
• Polytrauma in special populations
• Children
• Elderly
• Pregnant
• Current trends
• Conclusion
4. INTRODUCTION - Definitions
• Trauma – the exchange of energy between
the body and it’s environment exceeding it’s
resilience and leading to injury
• Significant trauma – is an injury which by
virtue of it’s location, extent, past or existing
complications, present or impending
haemodynamic instability will require hospital
admission and treatment
5. INTRODUCTION - Definitions
• Polytraumatised patient – is one who has
suffered 2 or more significant injuries to 2 or
more organ systems
• Emergency room – is a section of a healthcare
facility specializing in the provision of acute care
to patients presenting, without prior
appointment, with a broad spectrum of illnesses
and injuries which may be life-threatening,
arriving either by ambulance or their own means
6. INTRODUCTION – Epidemiology of
trauma
• Commonest cause of death in 1-44yrs
• 3rd
commonest cause of death overall
• Trauma mortality
– >90% of trauma mortality in low and middle
income countries
– 50% in 15-44yrs
– M:F = 2:1
– RTA commonest cause
7. INTRODUCTION – Epidemiology of
trauma
• In Nigeria,
• Prevalence – 11.2/100,000
• Age – 27+/- 13yrs
• Sex – M:F = 2:1
• Trauma mortality
– Avg age – 29.5yrs
– M:F = 2.5:1
– RTA – 75%
– Polytrauma – 60.9%
8. INTRODUCTION - Statement of
importance
• Trauma is a public health problem of epidemic
proportion, and from data just supplied,
mortality is more associated with polytrauma
than isolated injury.
• Judicious application of in-depth knowledge
and well-honed skills is mandatory in order to
curb its devastating effects on individuals and
society.
10. MECHANISMS OF INJURY
• Blunt
– RTA commonest cause
– Severity factors – mass & speed of vehicle, type of
vehicle, use of restraints, ejection from vehicle,
interaction with vehicle parts
• Penetrating
– Severity factors – mass & velocity of missile, viscera in
path of missile
• Blast
• Crush
• Thermal
11.
12.
13.
14. MECHANISMS OF INJURY
• Trimodal pattern of death following trauma
• Immediate death
(50%) – 0-1 hr
(massive head inj.)
• Early death
(30%) – 1-3 hrs
(chest inj, exsanguinatn)
• Late death
( 20%) – 1-6 wks
(sepsis, org failure)
15. MANAGEMENT
• Multidisciplinary
• Orthopaedic surgeon
• General surgeon
• Anaesthetist
• Trauma nurse
• Radiographer
• Other subspecialties, as needed
• Time is of essence
• Golden hour concept
16. MANAGEMENT
• Aim of management
‘To return patient to pre-injury status or as
near as possible’
• Scale of priorities
• Save life
• Save limb
• Save looks
17. MANAGEMENT
• ATLS
– Developed in USA
– Adopted globally
• ATLS philosophy
Treat lethal injuries first
Reassess
Treat again
18. MANAGEMENT
• Primary survey and resuscitation
– Identify and treat what is killing the patient.
• Secondary survey
– Proceed to identify other injuries.
• Definitive treatment
– Develop a definitive management plan
19. MANAGEMENT - Primary survey and
resuscitation
• A – airway and cervical spine protection
• B – breathing
• C – circulation and control of external
haemorrhage
• D – disability status
• E – exposure and environmental control
Caveat – when patient has catastrophic limb
haemorrhage CABCDE is practised
20. MANAGEMENT
• Airway obstruction in the polytraumatised
patient results in death in a few minutes and
must be addressed immediately
• Assume c-spine injury in all polytraumatised
patients and immobilize
• In-line immobilization
• Device combination – rigid c-collar, sandbags, head
strap
21.
22.
23. MANAGEMENT
• Airway assessment
• High risk injury – TBI (commonest cause), maxillofacial
injury, neck injury, inhalational burn injury
• If conscious, elicit speech e.g. ask name. if unconscious,
search for following features,
• Restlessness, sweating, cyanosis, resp. distress, noisy
breathing, hoarseness of voice, stridor
• Use dorsum of hand to feel for breath
24. MANAGEMENT
• Interventions
– Carried out without extending neck
– The manoevres are carried out in a methodical
fashion with the simpler ones attempted first
– It serves as a guideline, however special situations
may require modification
38. MANAGEMENT
• All polytraumatised patients should be given high
concentration oxygen at 15L/min via a
nonrebreathing face mask preferably
• Search for ‘lethal six’. Diagnosis is clinical.
– Airway obstruction – treated as previously stated
– Tension pneumothorax – cardinal signs are tracheal
deviation, hyperresonance, absent breath sounds.
Treatment: needle thoracostomy then CTTD
– Open pneumothorax
treatment: tape 3 sides of the wound leaving one side
for air venting
42. MANAGEMENT
• Circulation and control of external
haemorrhage
• Assessment
– Patient may be agitated, confused, pale,
dehydrated, cold clammy extremities, increased
capillary refill time. Pulses may be rapid and
thready, hypotensive, oliguric/anuric
• To identify site of haemorrhage remember,
‘Bleeding onto the floor and four more’
43. MANAGEMENT
• Treatment
– Pass 2 wide-bore iv cannulae, at same time blood is
obtained for invx.
– Commence on iv crystalloids – N/S or R/L, 2L bolus
(consider intraosseous in children with difficult veins)
– Control external haemorrhage by
• Pressure and elevation
• Clamping and ligation
• Tourniquets
• Windlass technique
• Quikclot or HemCon have been found to be useful
– Pass urethral catheter and commence hourly urine
output monitoring after emptying bladder
– Transfuse transient and non-responders
50. MANAGEMENT – secondary survey
• This is a detailed, systemic assessment of
patient to identify other injuries
• Usually done after primary survey but
sometimes may be done after surgery or in
the ICU
• ISS and MESS scores can be determined at this
time as well as more complex investigations
e.g. CT, MRI, angiography
51. MANAGEMENT
• Detailed history
– AMPLE
• Head-to-toe examination proceeding in a
systemic manner
– Head & face – open head injury, ocular inj, csf
otorrhoea or rhinorrhoea
– Neck – inspect for injury, swelling, palpate for
tenderness. Inspect c-spine starting from occiput.
Palpate for tenderness, haematoma, step
52. MANAGEMENT
• Chest – review primary survey and perform
full exam
• Abdomen and pelvis – inspect for distention,
penetrating wounds, palpate for tenderness, a
4-quadrant tap or DPL may be done at this
stage if haemoperitoneum is suspected. Pelvic
compression test. Inspect perineum for
lacerations, ecchymosis. Do DRE, and in the
female a vaginal exam in addition
53. MANAGEMENT
• Extremities – examine for swelling, deformity,
tenderness, crepitus. Note neurovascular status.
Obviously deformed limbs should be reduced and
immobilized using cast or traction for example
• Neurological assessment – full neurological exam
and sensory or motor deficit documented, spine
surgeons or neurosurgeons called in.
• Log-roll – requires at least 4people. Examine back
for swellings, wounds eg gunshot. Examine spine
from occiput to sacrum.
57. POLYTRAUMA IN SPECIAL
POPULATIONS
• Children
• Falls & RTA cause 90% of paediatric polytrauma
• RTA commonest cause of death
• Consider child abuse as a cause
• Dosing of fluids and medication according to weight is
essential
• Higher surface area-to-volume ratio means child is at greater
risk of hypothermia, increased emphasis on warmth
• Children have increased blood loss associated with long
bone and pelvic fractures compared with adults; therefore,
early splinting and stabilization are even more important
• Children initially respond to hypovolemia with tachycardia
and may not drop their blood pressure until they have lost
45% of their circulating volume
• Consider early transfer to a pediatric trauma center.
58. POLYTRAUMA IN SPECIAL
POPULATIONS
• Elderly
• Elderly are less likely to be involved in trauma but are more
likely to die from it
• Falls 2nd
commonest cause in 65-74yrs group; commonest in
>75yrs group
• Consider elder abuse as a cause
• Elderly may not be able to mount a tachycardic response to
shock because of medications or reduced sensitivity to
sympathetic outflow.
• A seemingly normal blood pressure might actually be
dangerously low in a patient with baseline hypertension
• Fluid overload may be as dangerous as hypovolemia.
Consider invasive monitoring
59. POLYTRAUMA IN SPECIAL
POPULATIONS
• Pregnant
• Trauma is commonest cause of non-obstetric M & M
• Patients at high risk of pulmonary aspiration, consider
early NG tube placement & rapid sequence intubation
if ET airway required
• After 12 wks, foetus is vulnerable to abdominal trauma
incurred by mother, therefore fetal age assessment
and viability becomes part of primary survey
• Early consultation with an obstetrician-gynecologist is
recommended
61. CONCLUSION
• Trauma remains the ‘neglected step-child of
modernisation’.
• The burden of trauma mortality, mainly
resulting from polytrauma, rests upon us in
developing nations.
• Training and retraining of doctors and
healthcare professionals as well as enactment
of adequate, specific and appropriate policy
with widespread implementation of same will
go a long way in lightening this burden.
63. REFERENCES
• Apley System of orthopaedics and fractures,
9th
Ed, pp627-687
• Bailey & Love short practice of surgery, 25th
Ed,
pp285-298
• http://emedicine.medscape.com/article/1270
888-overview#a6
• http://www.scopemed.org/?mno=9087
• Lateef O.A. Thanni (2011). Epidemiology of
Injuries in Nigeria—A Systematic review of
Mortality and Etiology. Prehospital and
Disaster Medicine, 26, pp 293-298