This document provides information on trauma management from the surgical club of Red Sea University. It discusses the phases of mortality from trauma, principles of triage, biomechanics of different injury types, and the ABCDE approach to the primary survey. For airway management, it describes techniques like chin lift, positioning, adjuncts, and definitive airways. It emphasizes controlling circulation through IV access, fluid resuscitation, and identifying/treating sources of hemorrhage in the primary survey. The goal is to recognize and stabilize life-threatening injuries in the first 10 minutes after trauma.
Trauma part 2 chest, abdomen, pelvic head and spine injuryAmar Yahia
This document provides an overview of trauma to the chest, abdomen, pelvis, head and spine. It begins by outlining the components of trauma management and classifications of chest injuries as immediately or potentially life-threatening. Specific conditions are described in detail such as tension pneumothorax, open pneumothorax, flail chest, and cardiac tamponade. Abdominal trauma is also classified and penetrating versus blunt mechanisms discussed. The approach to patients involves primary and secondary surveys, history taking, and diagnostic tests and imaging.
This document discusses wound healing, tissue repair, and scar formation. It begins with definitions of wounds and wound healing. Wounds are classified based on exposure to the external environment and thickness. The stages of wound healing are described as inflammatory, proliferative, and remodeling phases. Types of wound healing include primary intention, secondary intention, and tertiary intention. Factors affecting wound healing and complications are outlined. Specialized healing in nerves and bone is also reviewed.
1) The document discusses various types of surgical infections including their causes, risk factors, clinical features, investigations, management, and complications. It covers topics like cellulitis, lymphangitis, abscesses, furuncles, carbuncles, and tetanus.
2) Specific infections covered in detail include pyogenic abscesses, breast and peri-rectal abscesses, furuncles, hidradenitis, carbuncles, scalded skin syndrome, and impetigo.
3) Management involves drainage, antibiotics based on culture and sensitivity, surgery, vaccination against tetanus, and supportive care depending on the infection.
12 trauma – initial assessement and managementDang Thanh Tuan
The document discusses the initial assessment and management of trauma patients. It outlines the primary survey which focuses on identifying life-threatening conditions in the order of ABCDE - Airway, Breathing, Circulation, Disability, and Exposure. Maintaining the cervical spine is also a priority. Securing the airway may involve endotracheal intubation while assuming the cervical spine is unstable. Circulation is assessed through vital signs, pulses, and signs of shock with treatment of external and internal hemorrhage.
This document summarizes information presented by the Surgical Club of Red Sea University on the topic of burns. It discusses the function of skin, epidemiology of burns including risk factors, etiology and types of burns. It also covers the pathophysiology and pathology of burns including zones of injury and methods of assessing burn extent. Management of burns is outlined including first aid, indications for admission, fluid resuscitation, wound care, grafting and other reconstructive procedures. Complications, prognosis and references are also summarized.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
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
The ABCDE mnemonic is commonly used in first aid training and medical education to guide the assessment and initial management of trauma patients. It stands for:
A - Airway, B - Breathing, C - Circulation, D - Disability (neurological status), E - Exposure/environmental control. The mnemonic provides a systematic framework to survey a patient and identify any life-threatening injuries while beginning resuscitation efforts. Variations on the mnemonic order and additions have been developed for different contexts and levels of training.
Trauma part 2 chest, abdomen, pelvic head and spine injuryAmar Yahia
This document provides an overview of trauma to the chest, abdomen, pelvis, head and spine. It begins by outlining the components of trauma management and classifications of chest injuries as immediately or potentially life-threatening. Specific conditions are described in detail such as tension pneumothorax, open pneumothorax, flail chest, and cardiac tamponade. Abdominal trauma is also classified and penetrating versus blunt mechanisms discussed. The approach to patients involves primary and secondary surveys, history taking, and diagnostic tests and imaging.
This document discusses wound healing, tissue repair, and scar formation. It begins with definitions of wounds and wound healing. Wounds are classified based on exposure to the external environment and thickness. The stages of wound healing are described as inflammatory, proliferative, and remodeling phases. Types of wound healing include primary intention, secondary intention, and tertiary intention. Factors affecting wound healing and complications are outlined. Specialized healing in nerves and bone is also reviewed.
1) The document discusses various types of surgical infections including their causes, risk factors, clinical features, investigations, management, and complications. It covers topics like cellulitis, lymphangitis, abscesses, furuncles, carbuncles, and tetanus.
2) Specific infections covered in detail include pyogenic abscesses, breast and peri-rectal abscesses, furuncles, hidradenitis, carbuncles, scalded skin syndrome, and impetigo.
3) Management involves drainage, antibiotics based on culture and sensitivity, surgery, vaccination against tetanus, and supportive care depending on the infection.
12 trauma – initial assessement and managementDang Thanh Tuan
The document discusses the initial assessment and management of trauma patients. It outlines the primary survey which focuses on identifying life-threatening conditions in the order of ABCDE - Airway, Breathing, Circulation, Disability, and Exposure. Maintaining the cervical spine is also a priority. Securing the airway may involve endotracheal intubation while assuming the cervical spine is unstable. Circulation is assessed through vital signs, pulses, and signs of shock with treatment of external and internal hemorrhage.
This document summarizes information presented by the Surgical Club of Red Sea University on the topic of burns. It discusses the function of skin, epidemiology of burns including risk factors, etiology and types of burns. It also covers the pathophysiology and pathology of burns including zones of injury and methods of assessing burn extent. Management of burns is outlined including first aid, indications for admission, fluid resuscitation, wound care, grafting and other reconstructive procedures. Complications, prognosis and references are also summarized.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
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
The ABCDE mnemonic is commonly used in first aid training and medical education to guide the assessment and initial management of trauma patients. It stands for:
A - Airway, B - Breathing, C - Circulation, D - Disability (neurological status), E - Exposure/environmental control. The mnemonic provides a systematic framework to survey a patient and identify any life-threatening injuries while beginning resuscitation efforts. Variations on the mnemonic order and additions have been developed for different contexts and levels of training.
This document discusses the assessment and management of neck trauma, including penetrating trauma, blunt trauma, and strangulation injuries. It covers the pathophysiology, classification, clinical features, diagnostic evaluation and definitive treatment for various types of neck injuries. The management involves a structured approach to stabilize the patient, assess airway and vascular integrity, perform diagnostic studies as needed, and determine whether surgical intervention is required to address injuries from penetrating trauma or signs of injury from blunt trauma.
This document discusses the initial assessment and management of trauma patients based on ATLS guidelines. It covers the primary and secondary surveys, with a focus on airway management, breathing, circulation, disability, and exposure. Specific injuries such as tension pneumothorax, cardiac tamponade, and hemorrhagic shock are reviewed. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy are described as emergency procedures for trauma patients in shock. The document emphasizes treating the greatest threats to life first in trauma resuscitation.
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 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.
Penetrating neck injuries can involve important structures and require careful assessment and management. The document outlines:
1) A classification system for penetrating neck injuries based on location and depth. Zone I injuries below the cricoid cartilage pose the highest risk to major blood vessels.
2) A primary survey approach following ATLS guidelines is recommended to assess the airway, breathing, circulation, disability and environment. Hard signs of injury to airways or blood vessels require prompt surgical management.
3) Investigation may involve imaging like CT, Doppler ultrasound or angiography to identify injuries requiring surgery versus conservative management for stable patients with no signs of major injury. Early identification of injuries allows for proper treatment to prevent complications.
name of person assisting with transfer
Background: brief history of present illness and injury
Assessment: vital signs, GCS, injuries identified, procedures performed
Recommendation: level of care required, pending procedures or tests,
anticipated problems during transport
Fluid, electrolytes, and acid base balanceAmar Yahia
The document discusses fluid, electrolyte, and acid-base balance. It describes the composition of body fluid compartments, including total body water, intracellular water, extracellular water, plasma, and interstitial fluid. It discusses third space fluids and the osmolality of body fluids. Electrolytes such as sodium, potassium, calcium, magnesium, and chloride are described along with their general functions. Water imbalance in the form of water loss or excess is covered. Sodium and potassium metabolism and balance is explained in detail, including causes and treatment of deficiencies and excesses.
A 28-year-old male presented to the emergency room following a motor vehicle accident complaining of chest pain, a forehead laceration, right forearm pain, and multiple fractures. On examination, he had a Glasgow Coma Scale of 15/15 with stable vital signs. Imaging revealed multiple fractures and injuries consistent with polytrauma. Polytrauma, or multiple trauma, involves serious injuries to multiple body systems such as fractures and internal injuries from high-impact crashes. Proper management requires a team approach and stabilization of life-threatening injuries during the critical golden hour period.
Chapter2 trauma assessment and managementdjorgenmorris
The document outlines the steps in the ITLS trauma assessment process including the primary survey, ongoing exam, and secondary survey. The primary survey consists of a scene size-up, initial assessment including ABCs, and a rapid trauma survey or focused exam. Critical interventions should be performed without delay for conditions like airway obstruction or major bleeding. The ongoing exam monitors for changes. The secondary survey is a more thorough head-to-toe exam, which may be done en route or on scene for stable patients.
This document discusses musculo-skeletal trauma. It defines trauma and lists common causes including road traffic accidents, falls, sports injuries, and war or natural disasters. It describes priorities in trauma management and classifications systems used to assess injury severity. Supportive care needs for trauma patients are outlined. The challenges of treating musculoskeletal injuries are also discussed.
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.
The document describes a Rapid Response Team (RRT) and its purpose and functions. An RRT is a multidisciplinary team that provides critical care expertise to patients outside of ICU who show signs of deterioration. The key purposes of an RRT are to assess and stabilize deteriorating patients, provide support and early interventions to prevent further decline, and communicate with physicians. An effective RRT process includes detection of issues, team activation, response and assessment at the bedside, interventions and stabilization, and disposition/evaluation. The document outlines roles and responsibilities of the RRT, calling criteria, and how to structure, implement, and measure the effectiveness of an RRT.
Circumcision, cutting for the bladder stone, and trephination of the skull were three early surgical procedures performed in prehistoric times. Circumcision was practiced in Ancient Egypt on priests and royalty using crude stone instruments. Broken bones were splinted with bark or clay. Wounds were dressed with leaves, plants, cobwebs, ashes or dung. Termites or beetles were used to close wounds by biting the edges together. These practices provide insight into the rudimentary but essential early history of surgery performed by our ancestors.
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 provides an overview of primary care in trauma. It discusses the trimodal distribution of trauma deaths, the concept and principles of ATLS (Advanced Trauma Life Support), and the ABCDE approach to the initial assessment and management of trauma patients. Key steps include preparing the trauma team, conducting an initial assessment including primary and secondary surveys, and providing definitive care such as establishing an airway, controlling bleeding, and treating specific injuries. Special populations like children and the elderly require special considerations.
The document provides guidelines for the stabilization and management of polytrauma patients according to ATLS protocols. It describes the initial assessment of a hypothetical patient involved in a motorbike accident using the ABCDE approach. This includes securing the airway with cervical spine protection, treating breathing issues like tension pneumothorax, controlling hemorrhage, and assessing neurological status. It then outlines the steps for secondary survey, potential indications for emergency procedures, and guidelines for patient transfer to definitive care.
This document discusses management of traumatic cardiac arrest and compares it to medical cardiac arrest. It notes that traumatic cardiac arrest may have better outcomes if caused by penetrating trauma, witnessed arrest, presenting in PEA rhythm, and receiving prehospital medical management. Interventions for traumatic cardiac arrest focus on treating reversible causes like tension pneumothorax, relieving pericardial tamponade through resuscitative thoracotomy, controlling hemorrhage, and replacing blood loss. The role of chest compressions is de-emphasized. Teamwork between emergency responders, aeromedical services, and trauma centers is important for expeditiously managing traumatic cardiac arrest.
The document discusses the initial approach to trauma care, which consists of an initial primary assessment, rapid resuscitation, and a more thorough secondary assessment. The primary assessment focuses on identifying and treating life-threatening conditions by assessing ABCDE (airway, breathing, circulation, disability, exposure). Key interventions include controlling bleeding, treating pneumothorax, and addressing shock. A secondary assessment then provides a full head-to-toe examination to identify all injuries, with resuscitation continuing throughout. An organized team approach is emphasized to properly manage trauma in a timely manner.
1) Trauma management requires a systematic approach including preparation, triage, and assessment of airway, breathing, circulation, disability, and exposure (ABCDE).
2) During the primary survey, life-threatening conditions like tension pneumothorax, massive hemorrhage, and cardiac tamponade must be promptly identified and treated.
3) Establishing a secure airway is the initial priority, and may require basic maneuvers, advanced airways, or even surgical cricothyroidotomy if other methods fail.
This document discusses the assessment and management of neck trauma, including penetrating trauma, blunt trauma, and strangulation injuries. It covers the pathophysiology, classification, clinical features, diagnostic evaluation and definitive treatment for various types of neck injuries. The management involves a structured approach to stabilize the patient, assess airway and vascular integrity, perform diagnostic studies as needed, and determine whether surgical intervention is required to address injuries from penetrating trauma or signs of injury from blunt trauma.
This document discusses the initial assessment and management of trauma patients based on ATLS guidelines. It covers the primary and secondary surveys, with a focus on airway management, breathing, circulation, disability, and exposure. Specific injuries such as tension pneumothorax, cardiac tamponade, and hemorrhagic shock are reviewed. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy are described as emergency procedures for trauma patients in shock. The document emphasizes treating the greatest threats to life first in trauma resuscitation.
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 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.
Penetrating neck injuries can involve important structures and require careful assessment and management. The document outlines:
1) A classification system for penetrating neck injuries based on location and depth. Zone I injuries below the cricoid cartilage pose the highest risk to major blood vessels.
2) A primary survey approach following ATLS guidelines is recommended to assess the airway, breathing, circulation, disability and environment. Hard signs of injury to airways or blood vessels require prompt surgical management.
3) Investigation may involve imaging like CT, Doppler ultrasound or angiography to identify injuries requiring surgery versus conservative management for stable patients with no signs of major injury. Early identification of injuries allows for proper treatment to prevent complications.
name of person assisting with transfer
Background: brief history of present illness and injury
Assessment: vital signs, GCS, injuries identified, procedures performed
Recommendation: level of care required, pending procedures or tests,
anticipated problems during transport
Fluid, electrolytes, and acid base balanceAmar Yahia
The document discusses fluid, electrolyte, and acid-base balance. It describes the composition of body fluid compartments, including total body water, intracellular water, extracellular water, plasma, and interstitial fluid. It discusses third space fluids and the osmolality of body fluids. Electrolytes such as sodium, potassium, calcium, magnesium, and chloride are described along with their general functions. Water imbalance in the form of water loss or excess is covered. Sodium and potassium metabolism and balance is explained in detail, including causes and treatment of deficiencies and excesses.
A 28-year-old male presented to the emergency room following a motor vehicle accident complaining of chest pain, a forehead laceration, right forearm pain, and multiple fractures. On examination, he had a Glasgow Coma Scale of 15/15 with stable vital signs. Imaging revealed multiple fractures and injuries consistent with polytrauma. Polytrauma, or multiple trauma, involves serious injuries to multiple body systems such as fractures and internal injuries from high-impact crashes. Proper management requires a team approach and stabilization of life-threatening injuries during the critical golden hour period.
Chapter2 trauma assessment and managementdjorgenmorris
The document outlines the steps in the ITLS trauma assessment process including the primary survey, ongoing exam, and secondary survey. The primary survey consists of a scene size-up, initial assessment including ABCs, and a rapid trauma survey or focused exam. Critical interventions should be performed without delay for conditions like airway obstruction or major bleeding. The ongoing exam monitors for changes. The secondary survey is a more thorough head-to-toe exam, which may be done en route or on scene for stable patients.
This document discusses musculo-skeletal trauma. It defines trauma and lists common causes including road traffic accidents, falls, sports injuries, and war or natural disasters. It describes priorities in trauma management and classifications systems used to assess injury severity. Supportive care needs for trauma patients are outlined. The challenges of treating musculoskeletal injuries are also discussed.
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.
The document describes a Rapid Response Team (RRT) and its purpose and functions. An RRT is a multidisciplinary team that provides critical care expertise to patients outside of ICU who show signs of deterioration. The key purposes of an RRT are to assess and stabilize deteriorating patients, provide support and early interventions to prevent further decline, and communicate with physicians. An effective RRT process includes detection of issues, team activation, response and assessment at the bedside, interventions and stabilization, and disposition/evaluation. The document outlines roles and responsibilities of the RRT, calling criteria, and how to structure, implement, and measure the effectiveness of an RRT.
Circumcision, cutting for the bladder stone, and trephination of the skull were three early surgical procedures performed in prehistoric times. Circumcision was practiced in Ancient Egypt on priests and royalty using crude stone instruments. Broken bones were splinted with bark or clay. Wounds were dressed with leaves, plants, cobwebs, ashes or dung. Termites or beetles were used to close wounds by biting the edges together. These practices provide insight into the rudimentary but essential early history of surgery performed by our ancestors.
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 provides an overview of primary care in trauma. It discusses the trimodal distribution of trauma deaths, the concept and principles of ATLS (Advanced Trauma Life Support), and the ABCDE approach to the initial assessment and management of trauma patients. Key steps include preparing the trauma team, conducting an initial assessment including primary and secondary surveys, and providing definitive care such as establishing an airway, controlling bleeding, and treating specific injuries. Special populations like children and the elderly require special considerations.
The document provides guidelines for the stabilization and management of polytrauma patients according to ATLS protocols. It describes the initial assessment of a hypothetical patient involved in a motorbike accident using the ABCDE approach. This includes securing the airway with cervical spine protection, treating breathing issues like tension pneumothorax, controlling hemorrhage, and assessing neurological status. It then outlines the steps for secondary survey, potential indications for emergency procedures, and guidelines for patient transfer to definitive care.
This document discusses management of traumatic cardiac arrest and compares it to medical cardiac arrest. It notes that traumatic cardiac arrest may have better outcomes if caused by penetrating trauma, witnessed arrest, presenting in PEA rhythm, and receiving prehospital medical management. Interventions for traumatic cardiac arrest focus on treating reversible causes like tension pneumothorax, relieving pericardial tamponade through resuscitative thoracotomy, controlling hemorrhage, and replacing blood loss. The role of chest compressions is de-emphasized. Teamwork between emergency responders, aeromedical services, and trauma centers is important for expeditiously managing traumatic cardiac arrest.
The document discusses the initial approach to trauma care, which consists of an initial primary assessment, rapid resuscitation, and a more thorough secondary assessment. The primary assessment focuses on identifying and treating life-threatening conditions by assessing ABCDE (airway, breathing, circulation, disability, exposure). Key interventions include controlling bleeding, treating pneumothorax, and addressing shock. A secondary assessment then provides a full head-to-toe examination to identify all injuries, with resuscitation continuing throughout. An organized team approach is emphasized to properly manage trauma in a timely manner.
1) Trauma management requires a systematic approach including preparation, triage, and assessment of airway, breathing, circulation, disability, and exposure (ABCDE).
2) During the primary survey, life-threatening conditions like tension pneumothorax, massive hemorrhage, and cardiac tamponade must be promptly identified and treated.
3) Establishing a secure airway is the initial priority, and may require basic maneuvers, advanced airways, or even surgical cricothyroidotomy if other methods fail.
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.
Basic concept & management of Traumatology.pptDrRabbabImmul
1. The document discusses the basic concepts of traumatology and trauma management. It outlines the trimodal distribution of death following severe injuries, with immediate, early, and late deaths.
2. It describes the Advanced Trauma Life Support (ATLS) approach to trauma management, including the primary and secondary surveys to identify life-threatening injuries, resuscitate the patient, and develop a management plan.
3. Key aspects of the primary survey and resuscitation discussed are airway management, breathing/ventilation, hemorrhage control, and neurological examination to address the most serious threats and stabilize the patient.
BASIC ATLS principle, management and therapy.pptxAriefAbidin4
The Advanced Trauma Life Support (ATLS) system was created in the United States in 1976 after an orthopedic surgeon experienced inadequate emergency care following a plane crash that killed his wife and critically injured his children. ATLS focuses on the primary survey, simultaneous resuscitation, secondary survey, and definitive care of trauma patients. It emphasizes treating life-threatening injuries first. The program was adopted worldwide and over 50 countries now provide the ATLS course to physicians.
- The timeline concept in trauma management emphasizes that there is a critical time window to intervene before loss of compensatory mechanisms, and assessment and response should occur prior to irreversible damage.
- The primary survey follows the ATLS protocol of ABCDE to address life threats, while the secondary survey is a full head-to-toe examination.
- For physiologically compromised patients, a damage control approach may be necessary to stop bleeding and contamination before full treatment, while resuscitation continues simultaneously.
This document discusses the management of polytrauma patients. It defines polytrauma as injuries involving two or more major body systems. The goals of management are to save the patient's life, salvage limbs, and restore function if possible. A team approach is needed involving surgeons, physicians, and other specialists. The initial focus is a thorough primary survey and resuscitation to address life-threatening injuries like airway obstruction, hemorrhage, and spinal cord injury.
Trauma management was discussed including definitions, epidemiology, mechanisms of injury, and the golden hour concept. A systematic approach to trauma assessment and management was outlined including preparation, triage, primary survey using ABCDE, and secondary survey. Key points included recognizing life threats, establishing airway and C-spine control, assessing breathing and circulation to support oxygenation and perfusion, and rapid transport to an appropriate trauma center.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
Maxillofacial trauma requires aggressive airway management and preliminary care. The document outlines the steps for preliminary care which include:
1) Initial assessment of the patient using ABCDE to evaluate airway, breathing, circulation, disability and exposure.
2) Securing the airway through basic maneuvers like jaw thrust or advanced techniques like endotracheal intubation if needed.
3) Assessing breathing and managing thoracic injuries.
4) Controlling hemorrhage through circulation management and fluid resuscitation to restore perfusion.
5) Conducting a full secondary survey to identify all injuries.
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.
The document discusses the initial assessment and resuscitation of trauma patients using the ATLS protocol. It begins by outlining the importance of time in trauma care, known as the "golden hour". It then describes the ATLS protocol which includes preparation, triage, primary survey (ABCDE), resuscitation, secondary survey, and continued monitoring. The primary survey focuses on establishing the airway, breathing, circulation, disability level, and exposure. Maintaining the cervical spine is important when opening the airway.
This document provides information on the primary survey and resuscitation of trauma patients. It discusses the importance of the ABCDE approach to assess airway, breathing, circulation, disability, and exposure. Proper cervical spine control and airway management are emphasized as the first priorities in trauma resuscitation. Basic airway maneuvers like chin lift and jaw thrust are described, as well as advanced techniques like orotracheal intubation that provide a definitive airway. The document stresses the need for rapid evaluation and treatment of life-threatening injuries according to established trauma protocols.
The document outlines the steps of the Advanced Trauma Life Support protocol. It includes: 1) preparing equipment and summoning a trauma team, 2) performing triage on multiple casualties, 3) conducting a primary survey to address life threats like airway, breathing, circulation, disability and exposure, 4) providing resuscitation as needed, 5) using adjuncts like monitoring, IVs and diagnostics, 6) performing a full secondary survey and history, 7) using additional adjuncts, 8) continued re-evaluation of the patient, and 9) arranging for their definite care. The protocol aims to quickly identify and treat life threats in a trauma patient.
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
The document outlines the history and development of Advanced Trauma Life Support (ATLS). It describes the initial assessment process for trauma patients, including the primary and secondary surveys, with a focus on identifying and treating life-threatening injuries immediately. Specific types of injuries are discussed such as head trauma, thoracic trauma, abdominal/pelvic trauma. The goal of ATLS is to provide a standardized approach to trauma care through systematic assessment and simultaneous resuscitation to reduce mortality from traumatic injuries.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. Prepared by:
Dr. Amani abdelazim 18
Dr. Samah yagoob 18
Dr. Aisha Omar Hamid 18
Presented by:
Dr: Amar Yahia
Registrar of General Surgery
Surgical Club Red Sea University SC(RSU)24/7/2020
surgical club red sea university SC(RSU)
3. Trauma
Trauma is a major public health problem in all countries .
50% death in the first 10 minute after the accident.
mortality from trauma can be consider in 3 phases:
1- immediate phase death : they include massive brain
injuries , great vessels injuries ( aortic avulsion) , air way
occlusion , spinal cord transection and massive
hemorrhages. surgical club red sea university SC(RSU)
4. 2- early phase death : occur within the first minutes to hours (
called golden hours).
3-late phase death: occurs days to weeks after the injury.
Death can occurs duo to sepsis and multiple organ system
failure.
surgical club red sea university SC(RSU)
8. Triage
Triage means “To sort” in French.
Triage means sorting and treating patients according to
priority, which is usually determined by:
Medical need
Personnel available
Resources available.
surgical club red sea university SC(RSU)
10. -When there is sufficient treatment capacity to deal with
multiple casualties, patients with life threatening and
multisystem injuries are treated first.
-When there is insufficient treatment capacity to deal
with multiple casualties, patients with the greatest
chance of survival are treated first.
surgical club red sea university SC(RSU)
11. Triage Tags:
1. Red: Immediate
2. Yellow: Delayed
3. Green: Walking Wounded, Minor
4. Black: Expectant, deceased
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12. How do we determine what color a patient gets?
• Respirations: If > 30 or < 8
• Perfusion: If the patient has no radial pulses
surgical club red sea university SC(RSU)
13. Anyone who gets up and walks to the designated
area is given a green tag
Anyone who is not breathing is given a black tag
Anyone who fails one of the RPM assessments is given
a red tag
Anyone who cannot walk but passes all of the
assessments is given a yellow tag
surgical club red sea university SC(RSU)
14. Biomechanics of injury
Trauma may be sustained by means of:
-Blunt trauma .
-Penetrating injury.
-Deceleration injury.
-Crush injury.
-Burn injury.
-Hypothermia and hyperthermia.
-Barotrauma. surgical club red sea university SC(RSU)
15. Blunt trauma:
RTAs are the most common cause of blunt trauma and
are usually associated with:
head and neck (50%),
chest (20%), or
abdominal and pelvic trauma (25%).
surgical club red sea university SC(RSU)
17. A careful history of the:
1. mechanism of injury,
2. combined impact speed,
3. whether a seat belt was worn or an airbag inflated,
4. whether pedestrian or motorcyclist,
will enable the trauma surgeon to develop an idea of
which areas of the body and underlying organs are at risk.
surgical club red sea university SC(RSU)
21. Investigations are useful but should not delay an
essential laparotomy.
laparotomy is necessary in about 10% of blunt trauma
patients.
surgical club red sea university SC(RSU)
23. Penetrating injury:
May be solitary or multiple injuries
sucks dirt, clothing and skin into the wound, increasing
the risk of secondary infection
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24. Advanced trauma life support (ATLS) is essential for
first hour care of an injured patient.
Pre-hospital trauma life support (PHTLS) is to prevent
deaths while injured patients are transported to the
hospital.
surgical club red sea university SC(RSU)
25. Pre hospital care :
✓ The primary role of pre-hospital care is to:
o Temporarily stabilize the patient
o Early transport of the severely injured patient to the
site of definitive treatment
✓ Pre-hospital treatment is driven by rapid
assessment and the principles of ATLS.
surgical club red sea university SC(RSU)
27. Pre-hospital resuscitation follows ATLS principles:
1. C-spine immobilization : in-line immobilization
with a hard collar, sandbags and tape
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30. 2. Airway management:
Can be difficult.
Can often be maintained with basic measures.
Intubation without anesthesia and rapid sequence
induction is ill-advised because it can induce
vomiting and raise intracranial pressure ·
surgical club red sea university SC(RSU)
33. Circulation:
hemorrhage should be controlled with direct pressure
ensure good venous access before releasing from
vehicle.
Fluid resuscitation should be given to a systolic blood
pressure of 90 mmHg
surgical club red sea university SC(RSU)
38. Analgesia:
can be achieved with ketamine or Entonox
(contraindicated if possibility of pneumothorax or basal
skull fracture)
surgical club red sea university SC(RSU)
39. ATLAS Protocol
I. Primary survey
• Identify life-threatening conditions.
II. Adjunct to primary survey
• Investigations
III. Secondary Survey
• Re-evaluate the patient completely again.
IV. Definitive Care surgical club red sea university SC(RSU)
40. Resuscitation: the primary survey
The ABCDE protocol is the standard management of
trauma patients.
It is based on the ATLS format and involves
surgical club red sea university SC(RSU)
42. The important principles to remember are:
✓ Always assess a trauma patient in this order (ABCDE).
✓ If there is an immediately life-threatening problem in A, you
cannot proceed to B until the airway is secured.
✓ continuous reassessment and adjustment in response to
changing needs.
✓ In a severely injured patient you may never get to E
surgical club red sea university SC(RSU)
43. Assessment of the airway in the primary survey :
Is the airway compromised?
1. No ventilatory effort.
2. Cyanosis, stridor, use of accessory muscles .
3. Patient unable to speak although conscious.
surgical club red sea university SC(RSU)
44. immediate management of air way by one of the following:
1. Clear mouth of foreign bodies or secretions
2. Chin lift, jaw thrust
3. Establish oral or nasopharyngeal airway with bag-and-mask
ventilation
4. Definitive airway (intubation) and ventilation.
5. Surgical airway and ventilation.
surgical club red sea university SC(RSU)
49. - Is the airway at risk but currently not
compromised?
- Decrease GCS score
- Facial trauma
- Burn to face
- If so, call for anesthetic/ENT support and be prepared to
provide a definitive airway if needed. Constantly
reassess the situation. surgical club red sea university SC(RSU)
50. Eye Opening
Spontaneous 4
To speech 3
To pain 2
None 1
Verbal Response
Oriented 5
Confused 4
Inappropriate words 3
Moans 2
None 1
Best Motor Response
Follows commands 6
Localizes pain 5
Withdrawals 4
Decorticate (Flexion) 3
Decerebrate (Extension) 2
None 1
Note: Glasgow Coma Scale score = E
+ V + M; minimum score is 3,
maximum is 15.
surgical club red sea university SC(RSU)
54. Hypoxia is the quickest killer of trauma patients, so
maintenance of a patent airway and adequate oxygen
delivery are essential.
Remember that all trauma patients must be assumed to have
a cervical spine injury until proved otherwise.
surgical club red sea university SC(RSU)
55. Is the airway safe?
Patient speaking
Good air movement without stridor
If so, give oxygen and move on to assess breathing
surgical club red sea university SC(RSU)
56. Control of the C-spine in the primary survey by:
1. In-line survey manual immobilization (assistant holds
patient's head with both hands) or
2. Hard cervical spine collar with sandbag and tape
The C-spine should be controlled throughout the
primary survey until it fully assessed by clinically and, if
necessary, radiologically.
surgical club red sea university SC(RSU)
59. Management of a compromised airway:
Chin lift and jaw thrust
Guedel airway
nasopharyngeal airway
Definitive airway:
• Nasotracheal • Orotracheal • Cricothyroidotomy
• Tracheostomy
surgical club red sea university SC(RSU)
60. Remember, if the airway is obstructed you cannot move
on to assess breathing until the airway is secured
surgical club red sea university SC(RSU)
61. The 'chin lift' and 'jaw thrust :
Advantages:
1. no additional equipment needed.
2. Holding both sides of the head may be combined with
temporary in-line stabilization of the C-spine.
3. Can be used in a conscious patient.
Disadvantages:
1. requires practice to maintain airway.
2. Difficult to maintain for long periods of time
surgical club red sea university SC(RSU)
64. The Guedel airway :
Used for temporary bag-and-mask ventilation of the unconscious patient
before intubation.
Advantages:
easy to insert, widely available, various sizes.
Disadvantages:
1. sited above vocal folds so does not prevent airway obstruction at this
site.
2. Can provoke gag reflex.
3. Does not prevent aspiration of stomach contents
surgical club red sea university SC(RSU)
69. The nasopharyngeal airway
Used to prevent upper airway obstruction (e.g. in a drowsy/still-conscious patient).
Advantages:
fairly easy to insert; unlikely to stimulate gag reflex in comparison with
oropharyngeal (Guedel) airway.
Disadvantages:
1. less widely available,
2. uncomfortable for the patient,
3. sited above the vocal folds.
4. Insertion dangerous if facial trauma present.
5. Does not prevent aspiration of stomach contents.
surgical club red sea university SC(RSU)
71. The definitive airway
If the above measures are insufficient then a
definitive air way is indicated.
This will ensure free passage of oxygen to the trachea,
distal to the vocal folds.
surgical club red sea university SC(RSU)
72. Indications for a definitive airway :
1. Apnea
2. Hypoxia refractory to oxygen therapy.
3. Protection from aspiration pneumonitis.
4. Protection of the airway from impending obstruction due to
burns/edema/facial trauma/seizures.
5. Inability to maintain an airway by the above simpler measures .
6. Head injury with a risk of raised intracranial pressure (ICP).
7. Vocal fold paralysis. surgical club red sea university SC(RSU)
87. Breathing:
Assessment of breathing in the primary survey:
Full examination
Check saturation and/or arterial blood gases.
Provide supplemental oxygen .
surgical club red sea university SC(RSU)
88. 1. Clinical signs that should initially be evaluated include
symmetric chest movement.
cyanosis.
open chest wounds.
jugular venous distention (JVD).
respiratory rate.
use of accessory muscles of respiration (e.g.,
sternocleidomastoid).
surgical club red sea university SC(RSU)
89. 2. During auscultation one should assess for
bilateral breath sounds.
wheezing.
stridor.
surgical club red sea university SC(RSU)
90. 3. Palpation should be performed to assess for
tracheal position (a deviated trachea may indicate a
tension pneumothorax).
gross deformities.
subcutaneous emphysema.
flail segments.
surgical club red sea university SC(RSU)
91. Identify any of the six immediately life-threatening chest
injuries and treat them immediately (ATOM FC).
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive hemothorax
Flail chest
Cardiac tamponade . surgical club red sea university SC(RSU)
92. Ensure ventilation is adequate before moving on to
assess circulation Supplemental oxygen must be
delivered to all trauma patients.
surgical club red sea university SC(RSU)
94. Circulation:
Assess hemodynamic status
Identify sites of hemorrhage
Establish IV access
Send off blood for cross-matching and other
investigations
Give a bolus of intravenous fluid if the patient is
shocked .
surgical club red sea university SC(RSU)
96. b. In children
an appropriate initial bolus is 20 mL/kg.
c. A type and crossmatch
should be performed immediately, although
Type O negative (O—;universal donor) blood should also
be immediately available.
surgical club red sea university SC(RSU)
97. 2. Aggressive fluid resuscitation
should be initiated at this time.
a. In adults
an initial 2 L bolus of crystalloid (e.g., lactated Ringer's) should
be given through two large-bore intravenous (IV) lines (i.e., 14–
16 gauge).
surgical club red sea university SC(RSU)
98. If the patient is hemodynamically unstable and losing blood,
action must be taken before moving on with the primary survey.
This may mean transferring the patient to the operating theatre
at this stage of the primary survey if there is uncontrolled internal
bleeding.
surgical club red sea university SC(RSU)
99. IV cannula color and sizes
surgical club red sea university SC(RSU)
103. Disability :
1. A rapid assessment should be performed of
mental status.
gross motor function.
gross sensory function.
surgical club red sea university SC(RSU)
104. 2. The AVPU mnemonic
is a quick method to describe the patient's level of
consciousness.
A = Alert.
V = responds to Vocal stimuli.
P = responds to Painful stimuli.
U = Unresponsive.
surgical club red sea university SC(RSU)
105. 3. The Glasgow Coma scale (GCS)
is essential for quantitative assessment of the patient's
neurologic status
4. Asymmetry in pupillary size and reactivity
suggests the presence of an intracranial injury.
surgical club red sea university SC(RSU)
106. 5. The main disabilities discovered during this phase
include
head injury.
altered level of consciousness secondary to ethanol or
other drugs (diagnosis of exclusion).
surgical club red sea university SC(RSU)
107. Exposure and environment
1. Remove the patient's clothes
to facilitate a thorough examination.
2. Examine the entire body surface
including log-rolling the patient to view the back and
buttocks for potential injuries.
surgical club red sea university SC(RSU)
108. 3. Maintain normothermia
with warm IV fluids, loose application of warm blankets,
and a warm environment.
4. Consider tetanus immunization
and antibiotic administration, if necessary.
5. Perform initial chest and pelvic radiographs.
surgical club red sea university SC(RSU)
111. 1-Take an AMPLE history
AMPLE mnemonic:
Allergies.
Medication.
Past medical history.
Last name.
Event of the injury. surgical club red sea university SC(RSU)
Completing the primary survey:
Monitoring and important investigations :
112. 2- Give analgesia.
3- Monitor:
Urine output.
Conscious level
Set up:
Pulse oximetry ·
ECG leads.
surgical club red sea university SC(RSU)
113. 4- Send blood investigations if not already done
Do the three trauma radiographs:
1. Anteroposterior (AP) chest .
2. Pelvis.
3. C-spine.
Fully reassess the ABCDEs
You are now ready to progress to the secondary survey.
surgical club red sea university SC(RSU)
116. The secondary survey:
starts after the initial resuscitation as the patient begins
to stabilize.
It is carried out while continually reassessing ABC.
Immediately life-threatening conditions should already
have been detected and treated.
Obtain a complete medical history
surgical club red sea university SC(RSU)
117. Complete head to toe examination
Obtain all necessary investigations: bloods,
radiographs (of cervical spine, chest and pelvis).
Perform any special procedures
Monitor patient's response to treatment
surgical club red sea university SC(RSU)
118. Looks for potentially life threatening which includes
(ATOM – PD):-
1) Aortic disruption
2) Trachea-esophageal disruption
3) Esophageal disruption
4) Myocardial contusion
5) Pulmonary contusion
6) Diaphragmatic disruption
surgical club red sea university SC(RSU)
119. Follow up with 'Fingers and tubes in every orifice'
➢ Per rectum.
➢ Per vagina.
Check ENT Nasogastric (NG) tube insertion (if no skull fracture).
Urinary catheter insertion if no evidence of genitourinary trauma.
surgical club red sea university SC(RSU)
120. The patient should be fully exposed in order to look for
any hidden injuries in the secondary survey.
Remember that the patient may already be hypothermic
and so maintenance of their body temperature is vital:
1. warmed fluids.
2. warm resuscitation room.
3. External warming devices (blankets, bear-hugger etc).
surgical club red sea university SC(RSU)
121. Secondary survey of the head
Neurological state :
1. Full GCS assessment
2. Pupils
3. eyes
Examination of the face
1. Check facial bones for stability
2. Loose or absent teeth
examination of the scalp
Presence of soft-tissue injuries/hematoma
surgical club red sea university SC(RSU)
123. Signs of skull fracture:
• Periorbital hematoma
• Scleral hematoma with no posterior margin
• Battle's sign
• Cerebrospinal fluid (CSF)/blood from ears or nose
surgical club red sea university SC(RSU)
124. Secondary survey of the neck :
Risk factors for cervical spine injury:
1. Any injury above the clavicle
2. High-speed RTA
3. Fall from height
neck examination :
1. Thorough palpation of bony prominences
2. Check for soft-tissue swellings
3. Check for muscle spasm surgical club red sea university SC(RSU)
125. Radiograph of C-spine Exclude:
• Penetrating injuries of the neck
• Subcutaneous emphysema
• Elevated jugular venous pressure (JVP)
surgical club red sea university SC(RSU)
126. Secondary survey of the thorax
Exclude pathology (pneumothorax, hemothorax, rib
fractures, mediastinal injury, cardiac contusion)
Examine the full respiratory system, especially reassessing
air entry inspect chest wall (bony or soft tissue injury,
subcutaneous emphysema) Chest radiograph ECG
ABG should be obtained to monitor whether ventilation is
adequate
surgical club red sea university SC(RSU)
127. Secondary survey of the abdomen:
examine thoroughly (abdominal wall injury suggests internal
viscus injury)
insertion of a NG tube to decompress the stomach is
suggested as long as there are no facial fractures or basal
skull fractures
Involve surgeons early if suspect internal injury after general
resuscitation the main decision to be made in this area is
whether a laparotomy is necessary
surgical club red sea university SC(RSU)
128. Secondary survey of the pelvis :
Check for bony instability which indicates significant
blood loss
surgical club red sea university SC(RSU)
129. urethral catheterization is performed only if there is no
evidence of genitourinary injury.
surgical club red sea university SC(RSU)
131. identify any genitourinary system injuries suggested
by:
1. high-riding prostate felt per rectum;
2. blood found on rectal examination;
3. blood found on vaginal examination;
4. blood at external urethral meatus;
5. gross hematuria .
surgical club red sea university SC(RSU)
132. Secondary survey of the extremities :
Examine the full extent of each limb (remember hands
and feet, including individual fingers and toes).
Exclude soft-tissue injury, bony injury, vascular injury,
neurological injury.
Control hemorrhage; elevate limb; apply direct pressure
(tourniquets are not favored).
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133. Correct any obvious bony deformity because this will
decrease: fat emboli; hemorrhage; soft-tissue injury;
requirement for analgesia; skin tension in dislocations.
Caution: check and document neurovascular supply to
limb before and after any manipulation
surgical club red sea university SC(RSU)
134. Secondary survey of the spine :
examine the spinal column for alignment, stepping and
tenderness .
examine the peripheral and central nervous systems.
Exclude sensory or motor deficits
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135. Tetanus status and prophylaxis :
Major injuryMinor injuryTetanus status
Tetanus toxoid and tetanus
IgG
Tetanus toxoid only
Un known or fewer than three
doses
No treatment necessaryNo treatment needed
Full course received with last
booster < 10years ago
Tetanus IgGTetanus IgG
Full course received with last
booster > 10 years ago
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138. References :
❑ MRCS Part A_ Essential Revision Notes_ Book 1).
❑ ATLS® Advanced trauma life support® student course manual Tenth edition
❑ Primary Trauma Care Course Manual 2015 Edition
❑ SRB manual of surgery 5th edition .
❑ Bailey & Love’s Short Practice Of Surgery 26th Edition
❑ BRS General Surgery 1st edition
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