Presentation on theme: "Management Of Multiply Injured Patients By: Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB."— Presentation transcript:
Management Of Multiply Injured Patients By: Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB
Trauma Trauma claims the life of millions every year. Mostly it affects young age group-the productive section of society. Visit Trauma.org and look at the instantly changing no.of mortality due to trauma. TIME NOW TRAUMA DEATHS SINCE MIDNIGHT
TIME OF ESSENCE What are areas where time is wasted? Trimodal death and the Golden Hour 3 peaks of death 1 st peak-seconds to minutes after injury-due to brain lacerations,rupture aorta…. 2 nd peak minutes to hours after injury-the peak of avoidable death-the golden Hour 3 rd peak in ICU-due to sepsis, MOD….. WHERE DO U PUT YOUR MONEY?
Time of essence Yes exactly It is in the Golden Hour So again where is waste of time usuallly occur? 1.in the field: Scoop and run – not stay and play 2.in hospital: be prepared mobilize Trauma Team
prioritization Triaging according to : Salvagability: Donot waste time on unsalvagable cases Severity of injury(ABCDE): Donot waste time on
Spicy Pizza Ensure your safety and yor team Triage multiple casualities Prioritize (ABCDE)&manage accordingly Notify the hospital Scoop and run
Spicy pizza in hospital Do Primary Survey-minutes only What is primary survey? ABCDE Talk to the victim:a verbal response means a patent airway and reasonable breathing. If no verbal reponse then The Pizza Indian spicy&v. hot
ABCDE Airway and C–spine immobilization Breathing Circulation Disability Exposure / Environment control
ABCDE Open the airway: chin lift& jaw thrust No head tilt No hyperextension No hyperflexion No rotation But maintain on-line immobilization May need adjuncts
airway Oro&nasopharyngeal airway Suction Removal of denture,FB… Ambu-bag Endotracheal intubation, LMA Cricothyrotomy C-spine immobilization In short: maintain the airway
Breathing 4 conditions need to be recognized-treated Tension pneumothorax Open pneumothrax Flial chest Massive hemothorax The good news is--- u need 2 tubes&1 needle and mask Most life-threatening thoracic injuries can be treated by airway control, needle/chest tube insertion
Thoracic injuries Inspect---close an open pneumoth. Palpate –flial chest: may need intubation? Percuss& auscultate needle for tension pneumoth ---tube for massive hemothorax +? Blood & R/L solution. Again u need 2 tubes,needle,and mask
Circulation -SHOCK Bleeding is the predominant cause of death. Shock recognition: pulse, skin color, level of conciousness. Pulse : rate. Volume and regularity. Bp -----late Anatomical vs physiological derangement These changes occur with bleeding anywhere— do I need to know the exact anatomical source? Not really ….early management is the same.
Hemorragic shock-management Support circulation and stop bleeding. Support circulation: 2 wide bore cannula 2L warmed R/L, blood Avoid hypothermia---risk of coagulopathy. Stop bleeding: stop external bleeding by direct pressure How about torniquet ? Only in bleeding amputated limb Splint fracture e.g pelvic fracture
TRANSIENT RESPONSE---WHY? Ongoing bleed….or may be..??? Other causes of shock-- obstructive shock Obstructive e.g tension pneumothorax & tamponade (treated by pericardiocentesis) Keep an eye open to other possibilities? Neurogenic shock: IVF + - vasopressors. Periodic re-evaluation esp indeterioration
D - Disability GCS or AVPU GCS 3-15: 3 worst, and 15 best What can cause abnormal GCS? Of course brain injury, but what else? Hypotension and hypoxia. Any deterioration of GCS is due to brain injury--- -check pulse-ox & vitals 1 st. Always assume spinal injury, so immobilize spines--- cervical collar & backboard.
E ----Exposure & Environment control Exposure is nessary for proper assessment, and to avoid missing injuries Avoid unnecessary exposure Warmed IVF Warm blankets Raise room temperature. Any relation between E & C ?