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Management Of Multiply Injured Patients

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1 Management Of Multiply Injured Patients
By: Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB

Trauma claims the life of millions every year. Mostly it affects young age group-the productive section of society. Visit and look at the instantly changing no.of mortality due to trauma. TIME NOW                   TRAUMA DEATHS SINCE MIDNIGHT                    

3 TIME OF ESSENCE What are areas where time is wasted?
Trimodal death and the Golden Hour 3 peaks of death 1st 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 Hour 3rd 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? the field: Scoop and run – not stay and play hospital: be prepared mobilize Trauma Team

5 prioritization Triaging according to :
Salvagability: Donot waste time on unsalvagable cases Severity of injury(ABCDE): Donot waste time on <life threatening injuries

6 Spicy Pizza Ensure your safety and yor team
Triage multiple casualities Prioritize (ABCDE)&manage accordingly Notify the hospital Scoop and run

7 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

8 ABCDE Airway and C–spine immobilization Breathing Circulation
Disability Exposure / Environment control

9 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

10 airway Oro&nasopharyngeal airway Suction Removal of denture ,FB…
Ambu-bag Endotracheal intubation, LMA Cricothyrotomy C-spine immobilization In short: maintain the airway

11 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

12 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

13 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.

14 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

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

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 injuries Avoid unnecessary exposure Warmed IVF Warm blankets Raise room temperature. Any relation between E & C ?

18 Adjuncts to primary survey
X-ray chest & pelvis - + C-spine Pulse-ox ECG monitoring NGT. Urinary catheter.

Consider transfer( remember time) …next…? Secondary survey: head- toe examination Re-evaluate and re-evaluate… Re-evaluate …. Re-evaluate…

20 summary Time of essssssence Triage according to salvagability
Prioritize according to ABCDE Early Recognition,Early intervention,Early transfer-scoop and run

21 Almond Board of California
Remember Never forget your ABC…what is ABC? Almond Board of California

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