2 TRAUMA DEATHS SINCE MIDNIGHT 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 NOWTRAUMA DEATHS SINCE MIDNIGHT
3 TIME OF ESSENCE What are areas where time is wasted? Trimodal death and the Golden Hour3 peaks of death1st peak-seconds to minutes after injury-due to brain lacerations,rupture aorta….2nd peak minutes to hours after injury-the peak of avoidable death-the golden Hour3rd peak in ICU-due to sepsis, MOD…..WHERE DO U PUT YOUR MONEY?
4 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 play2.in hospital: be preparedmobilize Trauma Team
5 prioritization Triaging according to : Salvagability: Donot waste time on unsalvagable casesSeverity of injury(ABCDE): Donot waste time on <life threatening injuries
6 Spicy Pizza Ensure your safety and yor team Triage multiple casualitiesPrioritize (ABCDE)&manage accordinglyNotify the hospitalScoop and run
7 Spicy pizza in hospital Do Primary Survey-minutes onlyWhat is primary survey? ABCDETalk to the victim:a verbal response meansa patent airway and reasonable breathing.If no verbal reponse thenThe Pizza Indian spicy&v. hot
8 ABCDE Airway and C–spine immobilization Breathing Circulation DisabilityExposure / Environment control
9 ABCDE Open the airway: chin lift& jaw thrust No head tilt No hyperextensionNo hyperflexionNo rotationBut maintain on-line immobilizationMay need adjuncts
10 airway Oro&nasopharyngeal airway Suction Removal of denture ,FB… Ambu-bagEndotracheal intubation, LMACricothyrotomyC-spine immobilizationIn short: maintain the airway
11 Breathing 4 conditions need to be recognized-treated Tension pneumothoraxOpen pneumothraxFlial chestMassive hemothoraxThe good news is---u need 2 tubes&1 needle and maskMost life-threatening thoracic injuries can be treated by airway control, needle/chest tube insertion
12 Thoracic injuries Inspect---close an open pneumoth. Palpate –flial chest: may need intubation?Percuss& auscultateneedle for tension pneumoth ---tube for massive hemothorax +?Blood & R/L solution.Again u need 2 tubes,needle,and mask
13 Circulation -SHOCK Bleeding is the predominant cause of death. Shock recognition:pulse, skin color , level of conciousness.Pulse : rate. Volume and regularity.Bp -----lateAnatomical vs physiological derangementThese changes occur with bleeding anywhere—do I need to know the exact anatomical source?Not really ….early management is the same.
14 Hemorragic shock-management Support circulation and stop bleeding.Support circulation: 2 wide bore cannula2L warmed R/L , bloodAvoid hypothermia---risk of coagulopathy.Stop bleeding:stop external bleeding by direct pressureHow about torniquet ?Only in bleeding amputated limbSplint fracture e.g pelvic fracture
15 TRANSIENT RESPONSE---WHY? Ongoing bleed….or may be ..???Other causes of shock-- obstructive shockObstructive e.g tension pneumothorax & tamponade (treated by pericardiocentesis)Keep an eye open to other possibilities?Neurogenic shock: IVF + - vasopressors.Periodic re-evaluation esp indeterioration
16 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 1st .Always assume spinal injury , so immobilize spines--- cervical collar & backboard.
17 E ----Exposure & Environment control Exposure is nessary for proper assessment, and to avoid missing injuriesAvoid unnecessary exposureWarmed IVFWarm blanketsRaise room temperature.Any relation between E & C ?