2TRAUMA 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
3TIME 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?
4Time 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
5prioritization Triaging according to : Salvagability: Donot waste time on unsalvagable casesSeverity of injury(ABCDE): Donot waste time on <life threatening injuries
6Spicy Pizza Ensure your safety and yor team Triage multiple casualitiesPrioritize (ABCDE)&manage accordinglyNotify the hospitalScoop and run
7Spicy 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
8ABCDE Airway and C–spine immobilization Breathing Circulation DisabilityExposure / Environment control
9ABCDE Open the airway: chin lift& jaw thrust No head tilt No hyperextensionNo hyperflexionNo rotationBut maintain on-line immobilizationMay need adjuncts
10airway Oro&nasopharyngeal airway Suction Removal of denture ,FB… Ambu-bagEndotracheal intubation, LMACricothyrotomyC-spine immobilizationIn short: maintain the airway
11Breathing 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
12Thoracic 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
13Circulation -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.
14Hemorragic 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
15TRANSIENT 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
16D - 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.
17E ----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 ?