1. The primary survey involves rapidly assessing and treating life-threatening injuries by evaluating the patient's airway, breathing, circulation, disability, and exposure (ABCDE). This includes establishing an open airway, assessing breathing and ventilation, treating hemorrhagic shock, and providing spinal immobilization and intravenous access when needed.
2. The secondary survey is a head-to-toe examination to identify any injuries that may have been missed during the primary survey. It includes detailed examination of specific body regions like the head, neck, chest, abdomen, and extremities.
3. Effective trauma management requires a coordinated team approach with assigned roles. The goals are to rapidly identify and treat life-threatening injuries,
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
This document provides an overview of several ICU scoring systems used to evaluate severity of illness and predict outcomes in critically ill patients. It describes the components and scoring of systems such as APACHE, SAPS, SOFA, MODS, and LODS. APACHE uses physiological variables and chronic health factors to calculate mortality risk. SAPS and SAPS II similarly assess physiology but also include age and admission type. SOFA evaluates degree of organ dysfunction in six organ systems. MODS and LODS also score dysfunction across multiple organ systems based on laboratory and clinical findings.
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 document discusses the management of a polytrauma patient presenting with blunt abdominal trauma at POF Hospital. It describes the patient's presentation with shock and a grade 3 spleen injury found on FAST scan. Exploratory laparotomy revealed additional injuries including a grade 5 splenic injury and grade 4 renal injury. Definitive surgical management included splenectomy, nephrectomy, and sigmoid colostomy. The patient recovered well after multiple blood transfusions and other supportive care. Key components of polytrauma management include primary and secondary surveys, resuscitation, diagnostic studies like FAST scan, and definitive surgical or conservative treatment of injuries.
The document discusses Advance Trauma Life Support (ATLS). It describes ATLS as a general guideline for managing trauma patients that focuses on urgent problems during the critical "Golden Hour" period. The key components of ATLS include triage, primary survey and resuscitation (addressing ABCDE - Airway, Breathing, Circulation, Disability, Exposure), secondary survey to identify all injuries, and definitive care involving specialist treatment of injuries identified. The goal of ATLS is to prioritize assessment and rapid intervention for life-threatening injuries during the initial stages after trauma occurs.
Initial management of polytrauma patients requires a systematic approach with airway, breathing, and circulation as top priorities. The primary survey assesses these areas to identify life-threatening injuries, while the secondary survey provides a full head-to-toe examination to identify all injuries and guide further treatment. Trauma mortality follows a trimodal distribution with immediate deaths from major vascular or brain injuries within an hour, early deaths from hemorrhage or respiratory failure within hours, and late deaths after 3 days often from sepsis or organ failure.
Triage is the process of prioritizing patients according to the urgency of their need for care. It aims to ensure patients are treated in order of clinical urgency and receive timely care. There are three main types of triage - primary triage in the field, secondary triage in the emergency department, and tertiary triage by specialists. The START and SAVE methods are used for disaster triage in the field to categorize patients into immediate, delayed, or minimal care/expectant groups. In the ED, patients are assigned colors based on their condition - red for most urgent, yellow intermediate, green less urgent, and black for deceased. Documentation, equipment, and designated triage teams are needed to properly conduct triage
Advanced Trauma Life Support (ATLS) is a system to rapidly assess and treat trauma patients. It focuses on the initial care of trauma patients, with an emphasis on the first hour known as the "golden hour." The goal of ATLS is to rapidly identify and intervene in life-threatening injuries through a primary and secondary survey, resuscitation, and stabilization of the patient for transfer to the operating room or intensive care unit if needed. ATLS aims to minimize mortality and morbidity through structured training programs for medical professionals in trauma care.
Trauma management involves initial assessment and stabilization of airway, breathing, circulation, disability and exposure (ABCDE). The primary survey assesses life threats and guides resuscitation efforts. Key priorities include spinal immobilization, hemorrhage control, and treating tension pneumothorax. Secondary survey involves full head-to-toe examination and history to identify all injuries requiring attention or monitoring. Management requires a multidisciplinary team approach. Proper preparation and coordination of care is essential for optimal trauma outcomes.
This document provides an overview of several ICU scoring systems used to evaluate severity of illness and predict outcomes in critically ill patients. It describes the components and scoring of systems such as APACHE, SAPS, SOFA, MODS, and LODS. APACHE uses physiological variables and chronic health factors to calculate mortality risk. SAPS and SAPS II similarly assess physiology but also include age and admission type. SOFA evaluates degree of organ dysfunction in six organ systems. MODS and LODS also score dysfunction across multiple organ systems based on laboratory and clinical findings.
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 document discusses the management of a polytrauma patient presenting with blunt abdominal trauma at POF Hospital. It describes the patient's presentation with shock and a grade 3 spleen injury found on FAST scan. Exploratory laparotomy revealed additional injuries including a grade 5 splenic injury and grade 4 renal injury. Definitive surgical management included splenectomy, nephrectomy, and sigmoid colostomy. The patient recovered well after multiple blood transfusions and other supportive care. Key components of polytrauma management include primary and secondary surveys, resuscitation, diagnostic studies like FAST scan, and definitive surgical or conservative treatment of injuries.
The document discusses Advance Trauma Life Support (ATLS). It describes ATLS as a general guideline for managing trauma patients that focuses on urgent problems during the critical "Golden Hour" period. The key components of ATLS include triage, primary survey and resuscitation (addressing ABCDE - Airway, Breathing, Circulation, Disability, Exposure), secondary survey to identify all injuries, and definitive care involving specialist treatment of injuries identified. The goal of ATLS is to prioritize assessment and rapid intervention for life-threatening injuries during the initial stages after trauma occurs.
Initial management of polytrauma patients requires a systematic approach with airway, breathing, and circulation as top priorities. The primary survey assesses these areas to identify life-threatening injuries, while the secondary survey provides a full head-to-toe examination to identify all injuries and guide further treatment. Trauma mortality follows a trimodal distribution with immediate deaths from major vascular or brain injuries within an hour, early deaths from hemorrhage or respiratory failure within hours, and late deaths after 3 days often from sepsis or organ failure.
Triage is the process of prioritizing patients according to the urgency of their need for care. It aims to ensure patients are treated in order of clinical urgency and receive timely care. There are three main types of triage - primary triage in the field, secondary triage in the emergency department, and tertiary triage by specialists. The START and SAVE methods are used for disaster triage in the field to categorize patients into immediate, delayed, or minimal care/expectant groups. In the ED, patients are assigned colors based on their condition - red for most urgent, yellow intermediate, green less urgent, and black for deceased. Documentation, equipment, and designated triage teams are needed to properly conduct triage
Advanced Trauma Life Support (ATLS) is a system to rapidly assess and treat trauma patients. It focuses on the initial care of trauma patients, with an emphasis on the first hour known as the "golden hour." The goal of ATLS is to rapidly identify and intervene in life-threatening injuries through a primary and secondary survey, resuscitation, and stabilization of the patient for transfer to the operating room or intensive care unit if needed. ATLS aims to minimize mortality and morbidity through structured training programs for medical professionals in trauma care.
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.
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
Central venous catheterization and venous cut down techniques were presented. Central venous catheterization involves placing lines into large neck, chest, or groin veins and should only be done aseptically in operating rooms or high dependency units. It has indications for monitoring, infusing irritant drugs, pacing, dialysis, and emergencies. Sites include the subclavian, internal jugular, and femoral veins, each with advantages and disadvantages. Ultrasound guidance is becoming standard. Complications include infections, arterial puncture, and pneumothorax. Venous cut down is an open surgical technique to access veins and remains useful when other methods fail or are unavailable.
This document provides an overview of Advance Trauma Life Support (ATLS) principles from a presentation. It discusses the importance of the "golden hour" in trauma care. The objectives of ATLS are to prioritize patient assessment and management. It covers the basics of trauma assessment including preparation, triage, primary survey, resuscitation, secondary survey, and transfer to definitive care. The primary survey focuses on addressing life threats in order of airway, breathing, circulation, disability and exposure.
This document summarizes the 10th edition updates to the Advanced Trauma Life Support (ATLS) guidelines. It outlines the initial assessment process including the primary and secondary surveys. It provides updates to various body system-specific guidelines including new recommendations for airway management, shock classification and treatment, thoracic trauma management including tension pneumothorax, head trauma management including blood pressure targets, and spinal motion restriction. It also summarizes pediatric-specific guidelines including fluid resuscitation amounts and head CT criteria. Transfer communication is emphasized including avoiding unnecessary tests and using an ABC-SBAR template.
This document discusses critical care nursing concepts and definitions. It defines critical care as care for extremely ill patients whose conditions are unstable or potentially unstable. Critical care units provide comprehensive care for critically ill patients deemed recoverable. Critical care nursing involves specialized, individualized nursing services for patients with life-threatening conditions and their families. The document then reviews the history of critical care and intensive care units, as well as technologies used and classifications of critical care patients.
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the patients who need it most. It involves an initial assessment of patients upon arrival to identify life-threatening issues and prioritize patients into categories based on need. The document outlines the goals and categories of triage in both emergency and disaster situations, with categories ranked from resuscitation to non-urgent based on the threat to life, limb, or function. It also describes the key components of triage including an initial across-the-room assessment and ongoing re-assessments to adjust patient priority as needs change.
The initial assessment of a trauma patient involves a primary survey consisting of a rapid assessment of the airway, breathing, circulation, disability, and exposure (ABCDE). For a 34-year-old male brought to the emergency room after a road traffic accident with hoarseness, low blood pressure and rapid heart rate and breathing, the primary steps would be to open and secure the airway, assess breathing for tension pneumothorax, control bleeding, check neurological status, and fully expose the patient for further examination and resuscitation efforts. A secondary survey would then obtain a full history and examine all body regions for potential injuries.
Major Trauma Management and Trauma Team RolesSCGH ED CME
This document discusses major trauma management and trauma team roles. It defines major trauma as injury affecting more than one body system with an Injury Severity Score of over 15. The trauma network in Western Australia is described, with trauma accounting for a significant percentage of deaths and hospitalizations in Australia. When a major trauma code is called, the trauma team prepares and activates to receive the patient. Key roles on the trauma team include having the right people, equipment, drugs prepared and specialties notified. Hemostatic resuscitation principles are outlined, focusing on blood products over crystalloids to limit bleeding and following ratios like 1-2 units of red blood cells for every unit of plasma and platelets. Tranexamic acid should also
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
The document provides an overview of updates to the 10th edition of the Advanced Trauma Life Support (ATLS) guidelines. Key changes include a more judicious approach to fluid resuscitation, a focus on early use of blood products and management of coagulopathy, revisions to guidelines for needle thoracocentesis and management of tension pneumothorax, and emphasis on avoiding unnecessary imaging and procedures at primary hospitals to expedite transfer to definitive care facilities. The trauma team approach is highlighted throughout the new guidelines.
1) A 25-year-old male was in a high-speed head-on collision as an unrestrained driver and is unresponsive upon arrival with abnormal vital signs and injuries.
2) During the primary survey, the team will follow the ATLS protocol to simultaneously assess and treat the patient's airway, breathing, circulation, disability, and exposure (ABCDEs).
3) Adjuncts like diagnostic tools, vital sign monitoring, and urinary/gastric catheters will be used as needed during primary survey and resuscitation before proceeding to secondary survey and definitive care, with continuous re-evaluation of the stabilized patient.
Hemodynamic monitoring involves measuring various cardiovascular parameters at the bedside, including blood pressures, heart rate, cardiac output, and volumes. It provides important information to guide treatment for critically ill patients. The document discusses several hemodynamic monitoring methods and parameters in detail, such as arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring using catheters and transducers. It also covers topics like indications for hemodynamic monitoring, potential complications, and nursing considerations.
Management of polytraumatized patients focuses on organizing trauma teams and systems. The trauma team is assigned specific tasks to simultaneously address life-threatening injuries. A trauma system includes protocols like ATLS for managing multi-injured patients. ATLS emphasizes treating lethal injuries first through a primary survey addressing airway, breathing, circulation, disability and exposure. Secondary surveys then discover all other injuries to develop a definitive management plan. Proper triage also sorts patients by priority to maximize survival of the most severely injured.
An external ventricular drain (EVD) is used to temporarily drain cerebrospinal fluid (CSF) from the ventricles to relieve increased intracranial pressure or divert infected/bloody CSF. EVDs are commonly placed by junior staff as an emergency procedure, with proper technique and care important to avoid complications. Indications include relieving raised intracranial pressure, diverting infected or bloody CSF, or for intracranial pressure monitoring. Antibiotic-coated catheters can be left in place for up to 12 days. Complications include overdrainage, obstruction, infection, or hemorrhage.
The document discusses the primary survey and initial assessment of trauma patients. It outlines the steps as preparation, triage, primary survey (ABCDEs) with immediate resuscitation, secondary survey, and continued monitoring. The primary survey focuses on airway, breathing, circulation, disability, and exposure. Steps include maintaining the airway while restricting neck motion, assessing breathing, treating injuries impairing ventilation, and evaluating circulation and controlling hemorrhage.
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
The document discusses traumatology, which is the study and treatment of injuries caused by accidents or violence. It covers the branches of medical and psychological traumatology. It then discusses the Advanced Trauma Life Support (ATLS) protocol, which provides guidelines for assessing and stabilizing trauma patients. The ATLS protocol involves a primary survey to address life-threatening issues, a secondary survey for a full examination, and sometimes a tertiary survey. It emphasizes approaches like the ABCDE method, teamwork, triage, and ongoing monitoring of trauma patients.
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.
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
Central venous catheterization and venous cut down techniques were presented. Central venous catheterization involves placing lines into large neck, chest, or groin veins and should only be done aseptically in operating rooms or high dependency units. It has indications for monitoring, infusing irritant drugs, pacing, dialysis, and emergencies. Sites include the subclavian, internal jugular, and femoral veins, each with advantages and disadvantages. Ultrasound guidance is becoming standard. Complications include infections, arterial puncture, and pneumothorax. Venous cut down is an open surgical technique to access veins and remains useful when other methods fail or are unavailable.
This document provides an overview of Advance Trauma Life Support (ATLS) principles from a presentation. It discusses the importance of the "golden hour" in trauma care. The objectives of ATLS are to prioritize patient assessment and management. It covers the basics of trauma assessment including preparation, triage, primary survey, resuscitation, secondary survey, and transfer to definitive care. The primary survey focuses on addressing life threats in order of airway, breathing, circulation, disability and exposure.
This document summarizes the 10th edition updates to the Advanced Trauma Life Support (ATLS) guidelines. It outlines the initial assessment process including the primary and secondary surveys. It provides updates to various body system-specific guidelines including new recommendations for airway management, shock classification and treatment, thoracic trauma management including tension pneumothorax, head trauma management including blood pressure targets, and spinal motion restriction. It also summarizes pediatric-specific guidelines including fluid resuscitation amounts and head CT criteria. Transfer communication is emphasized including avoiding unnecessary tests and using an ABC-SBAR template.
This document discusses critical care nursing concepts and definitions. It defines critical care as care for extremely ill patients whose conditions are unstable or potentially unstable. Critical care units provide comprehensive care for critically ill patients deemed recoverable. Critical care nursing involves specialized, individualized nursing services for patients with life-threatening conditions and their families. The document then reviews the history of critical care and intensive care units, as well as technologies used and classifications of critical care patients.
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the patients who need it most. It involves an initial assessment of patients upon arrival to identify life-threatening issues and prioritize patients into categories based on need. The document outlines the goals and categories of triage in both emergency and disaster situations, with categories ranked from resuscitation to non-urgent based on the threat to life, limb, or function. It also describes the key components of triage including an initial across-the-room assessment and ongoing re-assessments to adjust patient priority as needs change.
The initial assessment of a trauma patient involves a primary survey consisting of a rapid assessment of the airway, breathing, circulation, disability, and exposure (ABCDE). For a 34-year-old male brought to the emergency room after a road traffic accident with hoarseness, low blood pressure and rapid heart rate and breathing, the primary steps would be to open and secure the airway, assess breathing for tension pneumothorax, control bleeding, check neurological status, and fully expose the patient for further examination and resuscitation efforts. A secondary survey would then obtain a full history and examine all body regions for potential injuries.
Major Trauma Management and Trauma Team RolesSCGH ED CME
This document discusses major trauma management and trauma team roles. It defines major trauma as injury affecting more than one body system with an Injury Severity Score of over 15. The trauma network in Western Australia is described, with trauma accounting for a significant percentage of deaths and hospitalizations in Australia. When a major trauma code is called, the trauma team prepares and activates to receive the patient. Key roles on the trauma team include having the right people, equipment, drugs prepared and specialties notified. Hemostatic resuscitation principles are outlined, focusing on blood products over crystalloids to limit bleeding and following ratios like 1-2 units of red blood cells for every unit of plasma and platelets. Tranexamic acid should also
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
The document provides an overview of updates to the 10th edition of the Advanced Trauma Life Support (ATLS) guidelines. Key changes include a more judicious approach to fluid resuscitation, a focus on early use of blood products and management of coagulopathy, revisions to guidelines for needle thoracocentesis and management of tension pneumothorax, and emphasis on avoiding unnecessary imaging and procedures at primary hospitals to expedite transfer to definitive care facilities. The trauma team approach is highlighted throughout the new guidelines.
1) A 25-year-old male was in a high-speed head-on collision as an unrestrained driver and is unresponsive upon arrival with abnormal vital signs and injuries.
2) During the primary survey, the team will follow the ATLS protocol to simultaneously assess and treat the patient's airway, breathing, circulation, disability, and exposure (ABCDEs).
3) Adjuncts like diagnostic tools, vital sign monitoring, and urinary/gastric catheters will be used as needed during primary survey and resuscitation before proceeding to secondary survey and definitive care, with continuous re-evaluation of the stabilized patient.
Hemodynamic monitoring involves measuring various cardiovascular parameters at the bedside, including blood pressures, heart rate, cardiac output, and volumes. It provides important information to guide treatment for critically ill patients. The document discusses several hemodynamic monitoring methods and parameters in detail, such as arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring using catheters and transducers. It also covers topics like indications for hemodynamic monitoring, potential complications, and nursing considerations.
Management of polytraumatized patients focuses on organizing trauma teams and systems. The trauma team is assigned specific tasks to simultaneously address life-threatening injuries. A trauma system includes protocols like ATLS for managing multi-injured patients. ATLS emphasizes treating lethal injuries first through a primary survey addressing airway, breathing, circulation, disability and exposure. Secondary surveys then discover all other injuries to develop a definitive management plan. Proper triage also sorts patients by priority to maximize survival of the most severely injured.
An external ventricular drain (EVD) is used to temporarily drain cerebrospinal fluid (CSF) from the ventricles to relieve increased intracranial pressure or divert infected/bloody CSF. EVDs are commonly placed by junior staff as an emergency procedure, with proper technique and care important to avoid complications. Indications include relieving raised intracranial pressure, diverting infected or bloody CSF, or for intracranial pressure monitoring. Antibiotic-coated catheters can be left in place for up to 12 days. Complications include overdrainage, obstruction, infection, or hemorrhage.
The document discusses the primary survey and initial assessment of trauma patients. It outlines the steps as preparation, triage, primary survey (ABCDEs) with immediate resuscitation, secondary survey, and continued monitoring. The primary survey focuses on airway, breathing, circulation, disability, and exposure. Steps include maintaining the airway while restricting neck motion, assessing breathing, treating injuries impairing ventilation, and evaluating circulation and controlling hemorrhage.
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
The document discusses traumatology, which is the study and treatment of injuries caused by accidents or violence. It covers the branches of medical and psychological traumatology. It then discusses the Advanced Trauma Life Support (ATLS) protocol, which provides guidelines for assessing and stabilizing trauma patients. The ATLS protocol involves a primary survey to address life-threatening issues, a secondary survey for a full examination, and sometimes a tertiary survey. It emphasizes approaches like the ABCDE method, teamwork, triage, and ongoing monitoring of trauma patients.
1. Polytrauma, or multiple trauma, refers to injuries to multiple body systems and regions resulting from severe trauma. It requires management by a multidisciplinary trauma team.
2. The document outlines the approach to polytrauma patients, including following ATLS protocols to address life-threatening injuries first through the primary and secondary surveys, resuscitation of airway, breathing, circulation, disability and exposure/environment, and then providing definitive care.
3. Key aspects of management include rapid triage, fluid resuscitation following the "3 for 1 rule", controlling hemorrhage from major sources, monitoring for shock, and ordering adjunct tests and monitoring as needed while stabilizing the patient.
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The document discusses anesthesia considerations for trauma patients. It notes that trauma is a leading cause of death worldwide and anesthesiologists are involved in trauma care from the emergency department through the operating room and intensive care unit. Anesthesia for trauma patients differs from routine cases as they often present off-hours, with limited information, multiple injuries requiring complex procedures. The document outlines priorities for trauma care including the ABCDE approach, indications for intubation, approaches to intubation, and prophylaxis against aspiration given trauma patients' risk of full stomachs.
Triage is the process of prioritizing patients according to the severity of their condition in order to ensure those with the most serious injuries receive care first when resources are limited. It involves classifying patients into categories based on initial assessments and then reassessing as needed. The goal is to do the most good for the most people using available resources. Triage methods like START and SAVE are used in disaster situations to rapidly assess and prioritize patients into categories to determine who should receive immediate care, delayed care, or comfort care only. In the emergency department, a triage team assesses all patients and assigns a color code category of red, yellow, green or black to indicate treatment priority and direct patients to the appropriate care area
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
1) Polytrauma refers to multiple injuries that affect multiple body systems and can lead to organ dysfunction or failure. It requires management by a team of surgeons and physicians, including an orthopedic surgeon.
2) The priorities in managing polytrauma are life salvage, limb salvage, and salvaging total function if possible. This involves controlling hemorrhage, treating life-threatening injuries, and splinting fractures while avoiding further injury.
3) Damage control orthopedics focuses on rapidly stabilizing fractures to control bleeding and prevent further tissue injury, while delaying more definitive fixation to avoid exacerbating the body's inflammatory response in critically injured patients.
Polytrauma refers to multiple injuries that affect multiple body systems. An orthopedic surgeon is part of the trauma team that manages polytrauma patients. The goals of polytrauma management are to save the patient's life, salvage any injured limbs, and restore the patient's pre-injury level of function if possible. The management involves assessing and stabilizing life-threatening injuries during the primary survey before conducting a full secondary survey. This includes maintaining the airway, breathing, circulation, and disability level using ATLS protocols. Definitive treatment of orthopedic injuries may be delayed to focus on life-saving interventions during the damage control phase.
This document discusses primary trauma care and outlines the steps for assessing and managing trauma patients. It covers triaging patients, performing a primary and secondary survey, identifying life-threatening injuries, providing initial resuscitation and stabilization, and determining appropriate disposition. The primary goals are to assess and treat airway, breathing, circulation and disability issues; control hemorrhage; and identify injuries requiring surgical intervention. Proper trauma management in the first hours can significantly impact outcomes.
1) Trauma deaths follow a trimodal distribution, with peaks occurring within seconds-minutes of injury due to severe brain or spinal cord injury, within minutes-hours due to hemorrhage, and days-weeks later due to sepsis or multiple organ failure.
2) The initial assessment and management of polytrauma patients follows the ABCDE approach, with simultaneous attention to the airway, breathing, circulation, disability, and exposure while preparing for further care and monitoring.
3) Secondary surveys involve a full physical exam, history taking, and diagnostic tests to identify all injuries and guide definitive care, which may involve patient transfer to a higher level trauma center if needed.
The document summarizes the steps of the Advanced Trauma Life Support (ATLS) process. It describes the primary survey with simultaneous resuscitation to identify life-threatening injuries, followed by a secondary survey to identify all other injuries. Finally, a definitive care plan is developed. The primary survey focuses on the ABCDE approach - Airway, Breathing, Circulation, Disability, and Exposure. Specific assessments and interventions are outlined for each step, including cervical spine precautions, tube thoracostomy, and full-body examination during the secondary survey. Maintaining spinal immobilization is emphasized throughout the trauma evaluation process.
INITIAL ASSESSMENT AND INTENSIVE CARE IN TRAUMA.pptxMahima Shanker
This document discusses the initial assessment and intensive care of trauma patients. It covers the trimodal distribution of trauma deaths, the importance of the "golden hour" period, and the steps of the primary and secondary surveys using the ABCDE approach. The primary survey involves assessing the airway, breathing, circulation, disability, and exposure. Key points include techniques for airway management and control of hemorrhage. Overall it provides an overview of the critical principles and processes for stabilizing trauma patients in the initial emergency period.
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
Polytrauma refers to injuries to two or more organ systems that are life threatening. It is a leading cause of death worldwide, especially among younger people. A polytrauma patient may have injuries to their head, chest, abdomen, pelvis or multiple long bone fractures. Immediate goals in treatment are to save the patient's life, limb, joint and restore function. Advanced Trauma Life Support (ATLS) protocols emphasize treating lethal threats like airway issues, bleeding and brain injuries first before fully assessing other injuries. The primary survey examines a patient's airway, breathing, circulation, disability and exposure to quickly identify and address life-threatening problems.
Polytrauma, or multiple severe injuries, is a leading cause of death worldwide especially among younger people. It involves injury to multiple body systems. Effective management requires a team-based approach that focuses on stabilizing the airway, breathing, and circulation during the primary survey before addressing specific injuries. The goals are to save the patient's life, preserve limbs if possible, and restore full function. Rapid assessment and treatment in the first hour, known as the "golden hour", significantly improves chances of survival.
Traumatology studies wounds and injuries caused by accidents or violence and their surgical treatment. The document discusses mechanisms of trauma including blunt and penetrating injuries. It describes the ABCDE approach to the trauma primary survey which rapidly identifies life-threatening conditions such as airway obstruction, tension pneumothorax, hemorrhage, and head injuries. The primary survey establishes airway, breathing and circulation before fully examining the patient and providing further treatment.
This document provides an overview of trauma and the approach to treating trauma patients. It discusses traumatology as a branch of medicine dealing with wounds and injuries. It describes mechanisms of injury including blunt and penetrating trauma. It outlines the ABCDE approach to the trauma primary survey to rapidly identify life-threatening conditions such as airway obstruction, tension pneumothorax, and hypovolemic shock. It also discusses taking a SAMPLE history and performing a secondary survey to fully examine the patient.
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.
Similar to Trauma Management in Primary Care Setting (20)
This document provides guidelines for the diagnosis, management, and follow-up of urinary tract infections (UTIs) in children. It recommends obtaining a urine sample from infants and children presenting with unexplained fever over 38°C to test for a UTI. Clean-catch urine samples are preferred for testing, and if not possible, catheterization or suprapubic aspiration should be used. Urine samples that cannot be cultured within 4 hours should be refrigerated or preserved. Based on microscopy and culture results, treatment with oral or intravenous antibiotics is recommended depending on the child's age and location of the infection. Imaging may be used depending on risk factors, and prophylactic antibiotics should be considered for recurrent UTIs.
This document discusses drug interactions, including definitions, types, mechanisms, high risk patients, and how to handle interactions. It notes the main types are drug-drug, herbal-drug, food-drug, and drink-drug interactions. Mechanisms include effects on absorption, distribution, metabolism, and excretion. Absorption can be affected by changes in pH, bacteria, insoluble complexes, or motility. Metabolism interactions involve enzyme induction or inhibition. The document provides examples of interactions and notes some drugs are more prone to interactions. It outlines approaches to preventing or managing interactions.
This presentation discusses high-alert medications, which are drugs that carry an increased risk of harming patients if used incorrectly. It identifies common classes of high-alert medications like opioids, insulin, and anticoagulants. Case scenarios are presented to demonstrate potential harms from improper use. Strategies are described for safely monitoring high-alert medications through standardization, redundancy checks, simplifying processes, and close patient monitoring.
This document presents two patient cases with hematuria and outlines guidelines for evaluating microscopic hematuria. Case 1 involved a 30-year-old female with burning during urination but no other symptoms. Examination found RBCs and leukocytes in the urine. She was treated with antibiotics which improved her symptoms. Case 2 was a 21-year-old male with blood in urine and weight loss. Examination was normal except for RBCs in urine. The document then outlines the definition, common causes, risk factors, initial investigations including urine analysis and imaging, and recommendations for cystoscopy depending on patient characteristics when evaluating microscopic hematuria.
This document provides guidance on evaluating and treating patients presenting with vaginal discharge. It begins with an overview of the objectives and causes of vaginitis. The most common causes are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. It describes taking a thorough history and physical exam, with attention to symptoms, signs, and diagnostic tests to identify the specific condition. Treatment recommendations are provided for the main diagnoses of candidiasis, bacterial vaginosis, trichomoniasis, chlamydia, and gonorrhea. A case presentation demonstrates applying this approach to diagnose and treat a patient with trichomoniasis based on her history, exam findings, and tests.
The document discusses mediations during the month of Ramadhan. Ramadhan is considered a holy month in the Islamic calendar where Muslims fast from dawn to dusk and focus on acts of worship, reflection, and charity. During this month, Muslims are encouraged to resolve conflicts peacefully through open communication and forgiveness.
An 18-year-old female missed one Microgynon 30 pill and had unprotected sex. The document states that no action is needed if one pill is missed at any time in the cycle. It provides guidelines for missed combined oral contraceptive pills and progestogen-only pills. The failure rate for male sterilization (vasectomy) is stated as 1 in 2,000.
This document discusses the evaluation and differential diagnosis of short stature in children. It defines short stature as a height more than 2 standard deviations below the mean for age and sex. The evaluation involves taking a history, performing a physical exam, assessing growth parameters, growth velocity, midparental height, bone age, and indications for further investigations. Common causes discussed are familial short stature, constitutional short stature, and pathological short stature. Treatment options mentioned include growth hormone, oxandrolone, IGF-1, and aromatase inhibitors.
This document discusses polycystic ovary syndrome (PCOS) in a 22-year-old woman presenting with irregular periods, weight gain, acne, and excess hair growth. PCOS is characterized by irregular periods, polycystic ovaries, and signs of excess androgens. It is associated with insulin resistance and increased risk of diabetes and heart disease. Treatment involves lifestyle changes, birth control pills to regulate periods and excess hair, and fertility medications like clomiphene to induce ovulation. Women with PCOS require screening for metabolic and endocrine conditions.
This document summarizes guidelines for screening and managing osteoporosis. It defines osteoporosis as a bone density T-score of -2.5 or lower according to WHO standards. All women over 65 should be screened by DXA scan, while younger women are screened if their 10-year fracture risk equals or exceeds an average 65-year-old woman. First-line treatment includes bisphosphonates along with lifestyle modifications like calcium and vitamin D. Screening and treatment decisions are also based on additional risk factors like prior fractures, smoking, glucocorticoid use, and family history.
This document discusses occupational disorders such as occupational asthma. Some key points are: occupational asthma accounts for about 15% of new asthma cases in adults and results in over 1 million disability cases annually. Diagnosis involves a work history and objective tests like spirometry. Treatment involves avoiding the causal agent, though symptoms may persist, as well as medications like inhaled corticosteroids. The prognosis is generally poor, with only 1/3 achieving long-term recovery even after avoiding exposure.
This 62-year-old lady presented with 5 days of painful right knee associated with redness and limping after trauma to the knee. Examination found fullness, redness, tenderness, warmth and restricted movement of the right knee. Differential diagnoses included fracture, septic arthritis, and allergy.
This document discusses a 52-year-old woman presenting with hot flashes and depression for 14 months without a period. It defines perimenopause, menopause and postmenopause. It recommends diagnosing perimenopause based on symptoms in women over 45 and managing hot flashes with HRT. It advises against using FSH to diagnose menopause in women using hormonal contraception. The risks and benefits of HRT are discussed as well as non-hormonal options for treatment.
Carbohydrates provide an important source of energy. Low-carbohydrate diets restrict carbohydrate intake, often below 130g per day, to induce weight loss. Very low-carbohydrate ketogenic diets reduce carbohydrates to less than 50g per day to produce ketosis, where the body uses fat instead of glucose for fuel. While low-carb diets may aid short-term weight loss, long-term safety and effectiveness require more research due to potential vitamin deficiencies or unfavorable cholesterol changes with strict low-carb intake.
Insomnia is defined as difficulty falling asleep, staying asleep, or early awakening despite opportunities for sleep, associated with impaired daytime functioning for at least 3 nights per week for over a month. It can be acute (under 3 months) or chronic. Assessment involves medical history, sleep history, and screening for sleep apnea, depression/anxiety, and other medical issues. Treatment goals are to improve sleep quality and quantity and daytime functioning. Non-pharmacological treatments like CBT, sleep hygiene, and sleep restriction are recommended initially. Hypnotics may be used short-term but have risks and should be avoided for chronic insomnia when possible.
This document discusses an approach to evaluating a patient presenting with fever and rash. It defines fever and rash and outlines an approach involving assessing severity, confirming fever type and rash characteristics, considering differential diagnoses, and developing an action plan. It then discusses two specific cases: measles in a 9-month old child presenting with maculopapular rash and supportive care is recommended; and rubella with its characteristic rash and Forschheimer spots and no specific treatment required beyond supportive care. Prevention of both involves the MMR vaccine.
A 33-year-old woman presents with weight loss, sweating, and tremors. Her thyroid function tests show hyperthyroidism. Graves' disease is the most likely diagnosis as it is the most common cause of thyrotoxicosis and her symptoms are typical. While eye signs are seen in 30% of Graves' patients, their absence does not rule out the diagnosis.
A series of multiple choice questions related to ENT conditions are presented. The questions cover topics like facial pain, hearing tests, sinusitis, trigeminal neuralgia, Meniere's disease, hereditary haemorrhagic telangiectasia, auricular haematomas, allergic rhinitis, nasal polyps, Epstein-Barr virus, and neck lumps. For each clinical scenario, learners are asked to choose the most likely diagnosis from a list of options. Explanations are provided for various conditions and test results.
A woman who is 31 weeks pregnant presents with an itchy rash on her abdomen and thighs. The most likely diagnosis is polymorphic eruption of pregnancy, which is a pruritic condition associated with the last trimester that often appears on the abdominal striae. A 54-year-old man is referred for symmetrical, erythematous, tender nodules on his shins, which is consistent with the characteristics of erythema nodosum. A 34-year-old man presents with an itchy rash on his genitals, palms, and around a recent scar, indicating the diagnosis of lichen planus.
1) The document discusses HPV vaccines for adolescents, recommending vaccination at ages 11-12 to protect against cancers caused by HPV. It describes three HPV vaccines that protect against different HPV types.
2) HPV is very common and can cause various cancers as well as genital warts. While most infections resolve, persistent infections can lead to cancer.
3) HPV vaccines have been found to be very safe and effective in clinical trials and in decreasing HPV-related infections and diseases in vaccinated populations.
- 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
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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4. Objectives
Epidemiolgy.
Component of trauma teams .
Goals of trauma management
Trauma management phases .
Primary survey.
Secondary survey .
Definitive treatment and management .
5. •Trauma is the leading cause of
death for people between ages
of 1-44 years ,,exceeded only by
cancer and atherosclerotic
diseases
6. Epidemiology
• Trauma is a leading cause of mortality globally
• Worldwide, road traffic injuries are the leading cause of death
between the ages of 18 and 29, while in the United States, trauma is
the leading cause of death in young adults and accounts for 10
percent of all deaths among men and women
• Over 45 million people sustain moderate to severe disability each
year due to trauma
• In the United States alone, more than 50 million patients receive
some form of trauma-related medical care for annually, and trauma
accounts for approximately 30 percent of all intensive care unit (ICU)
admissions.(up to date )
7. • Relatively few patients die after the first 24 hours following injury.
Rather, the majority of deaths occur either at the scene or within the
first four hours after the patient reaches a trauma center
8.
9. • The objectives of the initial evaluation of the trauma patient are as
follows:
(1) to rapidly identify life-threatening injuries,
(2) to initiate adequate supportive therapy,
(3) to efficiently organize either definitive therapy or transfer to a
facility that provides definitive therapy.
10. • Teams in primary health care centers including trained physicians and
nursing staff should be available ,in order to optimize patient care.
• Teams should use trauma team approach .each team member should
assigned a specific task or tasks so that each of these can be
performed simulataneously to ensure the most rapid possible
treatment
11. • Each person should be familiar with basic trauma resuscitation
• 1-BASIC LIFE SUPPORT (BLS)
• 2-ADVANCED TRAUMA LIFE SUPPORT (ATLS)
12.
13. Role of team leader
• Organizes the group
• Monitors individual performance of team members
• Backs up team members
• Models excellent team behavior
• Facilitates understanding
• Focuses on comprehensive patient care
14. Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
• Effective resuscitation team dynamics
16. Why ??
• Breakdowns in the care plan and medical mismanagement typically
occur due to one or more of four potential problems
●Communication breakdowns (eg, changes in the patient's physiologic
state or critical test results are not effectively communicated, overall
management plan or priority of tasks is not conveyed clearly by the
team leader)
●Failures in situational awareness (eg, failure to recognize shock, failure
to anticipate blood transfusion needs, failure to modify standard
management for higher risk patients).
17. ●Staffing or workload distribution problems (eg, insufficiently trained
staff conducting a procedure, inadequate staff for patient volume)
●Unresolved conflicts (eg, unresolved hostility about other team
members perceived to be performing inadequately, disagreement
about overall management plan, disagreement among senior clinicians
vying for team leadership)
18. • Principles of trauma patient management
• Treat the greatest threat to life first.
• Definitive diagnosis is not immediately important.
• Time matters (“golden hour” emphasizes urgency).
• Do no further harm.
• Assess, intervene, reassess
• Did the intervention work?
• Is the patient’s physiology returning to or staying normal
19. • While the most common causes of mortality from trauma are
hemorrhage, multiple organ dysfunction syndrome, and
cardiopulmonary arrest
• the most common preventable causes of morbidity are unintended
extubation , technical surgical failures, missed injuries, and
intravascular catheter-related complications .
24. • Triage:
• sorting and treating patients according to priority
identify, treat patients with life-threatening conditions first
• Priority may be determined by:
• Medical necessity
• Personnel skills
• Available equipment
25. Triage
• of trauma patients considers vital signs and prehospital clinical
course, mechanism of injury, patient age, and known or suspected
comorbid conditions.
• Findings that lead to an accelerated workup include multiple injuries,
extremes of age, evidence of severe neurologic injury, unstable vital
signs, and preexisting cardiac or pulmonary disease.
27. • Traumatic injuries can range from minor isolated wounds to complex
injuries involving multiple organ systems.
• All trauma patients require a systematic approach to management in
order to maximize outcomes and reduce the risk of undiscovered
injuries.
29. • In primary survey airway , breathing , circulation are assessed and
immediate life threatening problems are diagnosed and treated .
• A-airway
• B-breathing
• C –circulation
• D-disability
• E –exposure ,environment
30. ●Airway assessment and protection (maintain cervical spine
stabilization when appropriate)
●Breathing and ventilation assessment (maintain adequate
oxygenation)
●Circulation assessment (control hemorrhage and maintain adequate
end-organ perfusion)
●Disability assessment (perform basic neurologic evaluation)
●Exposure, with environmental control (undress patient and search
everywhere for possible injury, while preventing hypothermia)
31. • Primary survey usually takes no longer than few minutes , unless
procedures are required ,
• The primary survey must be repeated any time a patients status
changes , including changes in mental status , changes in vital signs
,or administration of new medications or treatment
32. • AIRWAY
• Always assess the airway
• • Talk to the patient – A patient speaking freely and clearly has an
open airway
• • Look and listen for signs of obstruction
• Snoring or gurgling
• Stridor or noisy breathing
• Foreign body or vomit in mouth
• if airway obstructed, open airway and clear obstruction
33. TECHNIQUES FOR OPENING THE AIRWAY
• No trauma
• Position patient on firm surface
• Tilt the head
• Lift the chin to open the airway
• Remove foreign body if visible
• Clear secretions
• Give oxygen 5 L/min
34. TECHNIQUES FOR OPENING THE AIRWAY
• In case of trauma •
• Stabilize cervical spine
• Do not lift head!
• Open airway using jaw thrust
• Remove foreign body if visible
• Clear secretions
• Give oxygen 5 L/min
35. AIRWAY DEVICES
• Oropharyngeal airway
• • Use if patient unconscious
• • Use correct size - measure from front of ear to corner of mouth
• • Slide airway over tongue
• If patient resists, gags or vomits, remove immediately!
36. • Nasopharyngeal airway
• • Better tolerated if patient is semi-conscious
• • Pass well lubricated into one nostril
• • Direct posteriorly, towards the throat
37. •In the unconscious patient, the airway
must be protected immediately once
any obstructions (eg, foreign body,
vomitus, displaced tongue) are removed
38. • Keep the following points in mind while performing the primary
survey:
• ●Airway obstruction is a major cause of death immediately following
trauma
• . The airway may be obstructed by the tongue, a foreign body,
aspirated material, tissue edema, or expanding hematoma.
• ●Once an airway has been established, it is important to secure it
well and to ensure it is not dislodged any time the patient is moved.
Unintended extubation is the most common preventable cause of
morbidity in trauma patients .(up to date)
39. TENSION PNEUMOTHORAX
• Air from lung puncture enters pleural space,
• cannot escape
• Progressive increase in intrathoracic
• pressure causes mediastinal shift and
• hypotension due to reduced venous return
• Patient becomes short of breath and hypoxic
• Diminished breath sounds on side of pneumothorax
• Requires urgent needle decompression,
• then chest drain as soon as possible
40. INDICATIONS FOR CHEST DECOMPRESSION
• Signs and Symptoms:
• Absent or diminished breath sounds on one side
• Evidence of chest trauma or rib fracture
• Open or "sucking" chest wound
• Diagnoses :
• Pneumothorax
• Tension pneumothorax
• Hemothorax
• Hemo-pnemothorax
41. Management :
• Give oxygen at 6-10 ml/min ,, via a non –rebreathing face mask , this
is indication for all patient suffering from polytrauma injuries
• Ventilate the patient with rescue breaths , a bag-valve device (bagging
the patient),or a ventilator but put it in mind that if the ventilation
problem is produced by a pneumothorax or tension
pneumothorax,intubation with vigorous bag-valve ventilation could
lead to further detoriartion of patient
• Treat open pneumothorax,tension pneumothorax,flail chest,massive
hemothorax( up to date)
42. • Insert a large bore needle over rib: – 2nd intercostal space – Over 3rd
rib at mid-clavicular line
• Listen for hissing sound of air escaping
• Insert chest drain
43.
44. BREATHING
• Assess ventilation - Is the patient in respiratory distress?
• Look – For cyanosis, wounds, deformities, ecchymosis, amplitude,
paradoxical movement
• Feel - Painful areas, abnormal movement
• Percuss - Dullness
• Listen - Reduced breath sounds
45.
46. • Airway patency alone doesn't assure adequate ventilation , adequate
gas exchange is required to maximize oxygenation and minimize
carbon dioxide accumulation ,
• Ventilation requires adequate function of the lungs ,chest wall ,
diaphragm , each component must be examined and evaluated
rapidly.
47. CIRCULATION: HAEMORRAGHIC SHOCK
• Assess the circulation
* Signs of hypoperfusion :
• Confusion, lethargy or agitation
• Pallor or cold extremities
• Weak or absent radial and femoral pulses
• Tachycardia
• Hypotension
Examine the abdomen for tenderness or guarding Carefully assess
pelvic stability
48.
49. •Hypotension generally does not
manifest until at least 30 percent of the
patient's blood volume has been lost
50. • Large volumes of blood may be hidden in thoracic, abdominal and
pelvic cavities, or from femoral shaft fractures
To decrease bleeding
Apply pressure to external wound
Apply splint to possible femur fracture
Apply pelvic binder to possible pelvic fracture
51. • Obtain two large bore IV catheters (14-16 gauge) using warmed fluids If
systolic BP <90 mmHg or pulse >110 bpm
• Give 500 ml bolus of Ringer’s Lactate or NS
• Keep patient warm
• Control hemorrhage by direct pressure over the wounds, tourniqutes
should be considered only in very limited conditions (traumatic
amputation).
• Perform CPR if needed
• Reassess vitals
• If still hypotensive after 2L of crystalloids, transfuse blood
52. INTRAVENOUS ACCESS
• Cannula should be placed in arm vein, not over joint, easy fixation.
Comfortable and convenient for drug administration and care
• Best veins in emergencies:
• Antecubital fossa
• Femoral
• External jugular
• Do not attempt subclavian vein due to high risk of pleural puncture
53. • Femoral vein
• If right handed, stand on patient’s right, palpate femoral artery
• Prep area carefully; site is contaminated
• Use a 14, 16 or 18 G (20 G in child) cannula mounted on 5 ml syringe
• Avoid injured extremities, if possible
54. • If patients is pregnant, she should not be on her back, put her on her
left side.
• Send blood for type and crossmatch
55. FLUIDS AND MEDICINES
• Avoid fluids containing dextrose during resuscitation
• Use Saline or Ringer's lactate
• For shocked patient: give fluids as fast as drip runs until blood
pressure responds
• May need a pressure infusion bag to push fluids
• Monitor response carefully; look at vital signs, urine output
Always give medicines intravenously during resuscitation
56. • Check the pulse using a pulse oximetre ,however ,remember that
pulse , oximetry can be unreliable in pateints with poor peripheral
perfusion after trauma..
57. • In trauma patients with significant hemorrhage, a lower score on the
Glasgow Coma Scale (GCS) and older age are both independently
associated with increased mortality, according to multivariable logistic
regression analysis of two large databases
58. Disability
• Checking for neurological damage: vital part of primary survey
Abbreviated neurological examination:
• – ALERT
• – VERBAL - responsive to verbal stimulus
• – PAIN - responsive to painful stimulus
• – UNRESPONSIVE
59. Glasgow coma scale
GCS is to be repeated
and recorded frequently.
It is the best way to
determine deterioration
60.
61. EXPOSURE
• Remove all patient's clothing
• Examine whole patient
• Front and back; log roll carefully
• Do not allow patient to get cold (especially children)
62.
63. • Cardiopulmonary resuscitation (CPR)
• (American heart association)
• >follow the C-A-B (compression –airway-breathing)
• >compression should be in a rate of 100/min moving the chest inward
at least 2 inches in adult and 13 of the chest diameter in children
• >compression ventilation ratio should be 30/2
• >minimize interruption to the chest compression .
66. • Start resuscitation at the same time as performing
primary survey Do not start secondary survey until
completing primary survey Constantly reassess
patient for response to treatment; if condition
deteriorates, reassess ABC.
67. Adjuncts to the primary survey
• Radiography :
• the “trauma triple”is portable cervical spine ,an anteroposterior
chest, an anteroposterior pelvis radiograph ,,, these provide the
maximum amount of information about potentially dangerous
conditions in a minimum amount of time
73. • Secondary survey
• Perform complete, thorough patient examination to ensure no other
injuries are missed
74. Secondary survey
• The secondary survey is performed only after the primary survey has
been finished and all immediate threats have been treated
• The secondary survey is a head to toe examination
• Dessigned to identify any injuries that might have been missed .
75. • Do not start definitive treatment until secondary survey is completed
unless required as life-saving measure
• When definitive treatment is not available, have a plan for safe
transfer of patient to another centre
76. Secondary survey
• Head Exam
• Scalp, eyes, ears
• Soft tissues
• Neck Exam
• Penetrating injuries
• Swelling or crepitus
• Neurological Exam
• Glasgow Coma Score
• Motor examination
• Sensory examination
• Reflexes
78. Patient history
• SAMPLE
• Symptoms –PAIN,shortness of breath ,other symptoms
• Allergies to medications
• Medications taken
• Past medical /surgical history
• Last meal –important to determine risk of aspiration
• Events Leading up to trauma
79. REASSESSMENT
• Always perform an ABCDE primary survey if patient deteriorates
• Signs of adequate resuscitation
• Slowing of tachycardia
• Urine output normalizes
• Blood pressure increases
80. MONITORING
• EKG monitoring if available
• Pulse oximeter
• Most widely used physiological monitoring device for heart rate,
oxygenation
• Especially useful in anaesthesia, ICU
• Simple to use
• Should be minimum standard of monitoring in every surgical theatre
• Blood pressure
• Manually or automated machine
81. Indication of referral to higher level
• 1- patient needs advanced care that is not available in the clinic
• 2- if there is a lack of skills , instruents , or equipment
• 3-lack of radiology services
82. Contraindication of referral to higher level
• 1-patients whose vital signs are unstable due to active bleeding ,
multiple fractures or suspicion of internal bleeding
• 2-patient with minor trauma not requiring any advanced medical
support.
83.
84. • Planning and preparation:
• Mode of transport
Accompanying personnel, including family
• Supplies needed for any possible treatment
• Identifying possible complications
• Communicate with all involved in transfer including receiving hospital
• Be prepared: if anything can go wrong, it will and at the worst
possible time
85. STABILIZATION AND TRANSFER
Resuscitation completed
Laboratory specimen sent
Controlled airway
Normalized circulation
Immobilized fractures
Appropriate analgesia
Functioning intravenous lines
Documentation completed
Transfer :
– Ward – Operating theatre – Higher level of care centre
86. • PATIENT SAFETY: Consent
• Informed consent means that patient and patient’s family understand
– What is to take place
• – Potential risks, complications of both proceeding and not
proceeding
• Have given permission for intervention
• Be attentive to legal, religious, cultural, linguistic, family norms and
differences Our job is not to judge, but to provide care to all without
regard to social status or any other considerations
87. • RECORD KEEPING
• • Essential that patients receive written note describing diagnosis,
procedure performed
• • All records should be clear, accurate, complete, signed
88.
89.
90. Elderly trauma
• Falls , motor vehicle accidents are the leading cause of trauma in
elderly .
• According to a systematic review of 18 studies, the probability of
falling at least once in any given year for individuals 65 years and
older is approximately 27 percent.(up to date ).
• Falls in the elderly most often occur from a standing position on a
level surface, with orthopedic injury (eg, hip or long bone fracture)
the most common significant complication.
91. • Elderly patients may be hypotensive relative to their baseline blood
pressure but still have blood pressure measurements in the "normal"
range. A single episode of hypotension substantially increases the
likelihood that a serious injury has occurred (up to date )
92. • Although there is little prospective data to guide triage decisions
about geriatric trauma patients, given the increased risk for severe
injury and death in this population, we suggest that trauma patients
over the age of 70 be evaluated at a trauma center with trauma team
activation whenever possible, regardless of the mechanism (ie, falls
from standing warrant such evaluation)(up to date )
93. Reference
• Who health organization (Emergency and Essential Surgical Care
(EESC) programme)
• Up to date
• American heart association (ATLS )