2. Trauma
Terminology:
• Injury = The result of harmful event that arises
from the release of specific forms of energy.
• “Trauma” = Injury of one or more systems,
that results in excessive bleeding and may
affect the normal body functioning.
3. EPIDEMIOLOGY
• 3242 persons die each day around the world.
• 50 million people are disabled or injured each year.
• India : 1%of motor vehicles in the world but bears
the burden of 6% of global vehicular accidents.
• Unfortunately, a majority of trauma survivors are
either confined to bed or wheel chair for the rest of
their lives.
• The tragedy of India :
78% of the victims – men, 20 to 44 years, causing
significant impact on productivity.
• A vehicular accident reported every 3 min and a
death every 6 min on Indian roads
5. Trauma deaths
FIRST PEAK
• Within minutes of injury
• Due to major neurological or vascular injury
• Medical treatment can rarely improve outcome
SECOND PEAK
• Occurs during the 'golden hour'
• Due to intracranial haematoma, major thoracic or abdominal injury
• Primary focus of intervention for the Advanced Trauma Life
Support (ATLS) methodology
THIRD PEAK
• Occurs after days or weeks
• Due to sepsis and multiple organ failure
6. Trauma
• Preparation and triage
• Primary Survey
• Adjuncts to primary survey
• Secondary Survey
• Adjuncts to secondary survey
• Definitive treatment
• Records, Consent, Forensic evidence
9. The process of categorizing victims or mass
casualties based on their need for treatment and
the resources available.
ITS MAIN GOALS ARE:
• Prevent avoidable deaths.
• Ensure proper initial treatment with a minimal
time frame.
• Avoid misusing asserts on hopeless cases.
10. MULTIPLE CASUALTIES
No. of patients and the severity of their injuries
do not exceed the ability of the facility to
provide care.
MASS CASUALTIES
The no. of patients and the severity of their
injuries exceed the ability of the facility to
provide care.
11. Assessment of the injured patient
Primary survey and resuscitation
A = Airway and cervical spine
B = Breathing
C = Circulation and hemorrhage control
D = Disability or Dysfunction of the central
nervous system
E = Exposure
12. Airway and cervical spine
• Always assume that patient has cervical spine
injury
• If patient can talk then he is able to maintain
own airway
• If airway compromised initially attempt a chin
lift and clear airway of foreign bodies.
• Intubate or cricothyroidotomy
• Give 100% Oxygen
13.
14. Breathing
• Check position of trachea, respiratory rate and
air entry
• If clinical evidence of tension pneumothorax
will need immediate relief
• Place venous cannula through second
intercostal space in the mid-clavicular line
• If open chest wound seal with occlusive
dressing
15. Circulation and hemorrhage control
• Assess pulse, capillary return and state of neck
veins
• Identify exsanguinating hemorrhage and apply
direct pressure.
• Place two large calibre intravenous cannulas
Give intravenous fluids
• Attach patient to ECG monitor
16. Disability or Dysfunction of the
central nervous system
Rapid assessment of neurologic status to identify
life-threatening injury
• Pupil size and response
• Mental status (Glasscow coma scale)
• Motor and sensory exam
17. Exposure
Head to toe examination of the patient for injury
• Pitfalls
- Maintenance of spine precautions
- Prevention of heat loss
- Under cervical collar
- Back and flanks
• Undress the patient completely but prevent
hypothermia.
• Logrolling and looking for back of the pt. is very
important
18. Adjuncts to the Primary Survey
• Exams during or after primary survey to aid in
identifying life-threatening injuries
- ECG
- Pulse oximetry
- Chest x-ray
- Pelvis x-ray
- ABGS
- Catheters
- Focused abdominal sonogram for trauma (FAST)
- Diagnostic peritoneal lavage (DPL)
o Resuscitation may be required in some cases.
19. Secondary survey
Secondary survey does not begin until the primary survey is
completed, resuscitative efforts are established and patient is
demonstrating normalization of vital functions.
It includes:
• Head to toe evaluation
• AMPLE history
- Allergy
- Medications currently taking
- Past illness
- Last meal
- Event/environment related to injury.
• Physical examination
• Reassessment of all vital organs
20. Adjuncts to the secondary survey
• CT SCAN
• CONTRAST STUDIES
• EXTREMITY XRAY
• ENDOSCOPY
• ULTRASONOGRAPHY
21. Definitive Treatment
Treatment plans, especially for multiple injuries,
based on clinical status and specific injuries.
• AFTER identifying the patients injury.
• Managing life threatening problems
• Obtaining special studies.
• If the patients injuries exceed the capabilities
of the institution.
22. Take home message
• ABCDE approach.
• Treat greatest threat to life.
• Definitive diagnosis is not immediately
important.
• Time is the essence.
• Do no further harm the patient.
