Presentation is loading. Please wait.

Presentation is loading. Please wait.

Approach to poly-trauma patient

Similar presentations

Presentation on theme: "Approach to poly-trauma patient"— Presentation transcript:

1 Approach to poly-trauma patient

2 What is polytrauma Multiple traumatic injuries to a victum.

3 Overview of ATLS

4 Types of assessment Primary Survey and resuscitation
Identification of Life threatening conditions AcBCDE Approach Secondary Survey Detailed head to toe examination Medical history All lab and radiology investigation ordered Management Plan

Identification of LIFE-THREATENING emergencies Assess – Change - Reassess Initiation of LIFE-SAVING measures (CPR) Illinois EMSC

6 5 second Round Pt is conscious or not Airway Ventilation
Signs of massive external hemorrhage There is any deformity Skin color and temp with feeling pulse Illinois EMSC

7 Primary Survey Airway/ Cervical Spine Control Breathing Circulation
Disability (neurological) Expose Illinois EMSC

8 Assessing Airway Is the airway: Clear and safe? At risk? Obstructed?

9 AIRWAY INTERVENTIONS Jaw thrust Vs Head tilt.
Deliver Oxygen (mask with reservoir). Use Rigid suction. Secure airway. Illinois EMSC

10 5 Chest clues in the neck Wounds Distended neck veins
Tracheal position Surgical emphysema Laryngeal crepitus

Place hands on either side of the head cervical collar.flv Maintain neck midline “manual in line stabilization” Illinois EMSC

12 Breathing and ventilation
Aims Support if inadequate Eliminate any immediately life threatening thoracic condition …..

13 Breathing and ventilation
Inspection Respiratory rate Effort of breathing Symmetry Wounds & marks Palpation Percussion Auscultation All lung zones

If breathing is absent, start ventilation using: Simple Adjuvants (Airways) Bag valve mask with reservoir LMA ETT Illinois EMSC

15 Surgical Airway Cricothyroidotomy (tracheostomy) Indication
Unable to intubate(sever maxillo-facial injury) Contraindication Transection of the airway

16 Fatal Chest conditions?
Tension pneumothorax Open chest trauma Cardiac tamponade Flail chest Massive hemothorax Illinois EMSC

17 Tension Pneumothorax Signs and Symptoms
Chest pain, respiratory distress, tachycardia, hypotension, tracheal deviation, absent breath sounds, neck vein distention. Immediate decompression Needle thoracostomy Chest tube insertion

Ensure adequate airway 100% oxygen Seal open wound Load & Go IV access en route Notify Medical Direction Courtesy of David Effron, M.D.

19 Open pneumothorax >2/3 of the tracheal diameter
3 sided wound dressing Chest tube insertion

20 SEALING THE OPEN WOUND Asherman chest seal is very effective

21 SEALING THE OPEN WOUND You can use impervious material taped on three sides

22 Cardiac temponade Penetrating injury Becks Triad
1) Elevated central venous pressure (distended neck veins) 2) Muffled heart sounds 3) low blood pressure FAST scan /ECHO Pericardiocentesis

23 Flail Chest > 2 ribs fractured in 2 or more places usually on the same or opposite side of the chest. Paradoxical chest wall movement. Adequate ventilation/ inadequate ventilation Chest tube insertion

24 Massive heamothorax >1500 cc or 1/3 of the blood volume in the lung cavity I/V resuscitation Chest tube insertion Thoracotomy > 1500 cc immediately 200 cc/h for 2-4 hours

Carotid pulse (absent or present) Capillary refill Skin color Skin temperature Sites of bleeding Illinois EMSC

If central pulse is absent, begin CPR Apply direct pressure to open wounds. IV access (2 wide bore cannulae14/16G). Fluids (colloids Vs crystalloids) 20ml/Kg Peripheral Vs central line?

27 Hemorrhagic Shock Most common cause of shock in trauma
External vs Internal hemorrhag Blood volume = 7% of BW Rx : Volume replacement Shock classification

28 Classification Type 1 - 15% blood loss - p<100 - BP Normal
- PP Normal - RR 14-20 - Urine output > 30cc/h - Mental status : Slightly anxious

29 Classification Type 2 - 15-30% blood loss - p>100 - BP Normal
- PP Decreased - RR 20-30 - Urine output cc/h - Mental status : Mildly anxious

30 Classification Type 3 - 30-40% blood loss - p>120 - BP Decreased
- PP Decreased - RR 30-40 - Urine output > 5-15cc/h - Mental status : Confused

31 Classification Type 4 - >40% blood loss - p>140 - BP Decreased
- PP Decreased - RR >35 - Urine output Nil - Mental status : Confused/ Lerthargic

32 Fluid Replacement Class 1-2 : Crystalloid
Class 3-4 : Crystalloid , Blood Initial Fluid Therapy - 1 to 2 L for adult - 20cc/kg for children “3-for-1 Rule” - 1cc blood loss = 3 cc crystalloid replacement

33 Response to Fluid resuscitation
Rapid response - < 20% blood loss - Cross match and surgical consult Transient response % blood loss - Ongoing blood loss - Blood transfusion, Surgical Intervention No response - Immediate operative intervention

34 Neurogenic Shock Isolated intracranial injuries do not cause shock.
Loss of sympathetic tone: Spinal cord injury Hypotension without tachycardia Initially treated as Hypovolemia DDx for non responder

35 Dysfunction of the CNS Aims Rapid neurological assessment
Alert; Voice; Pain; Unresponsive Pupils Mini-neurological assessment GCS score / AVPU Lateralising signs Blood sugar If GCS 8 or less intubate if not already done so

36 Factors affecting level of consciousness
Oxygenation Ventilation Perfusion Hypoglycemia Alcohol Trauma

37 Head injury severity GCS Mild 13-15 Moderate 9-12 Severe <8

38 Head injury Types Skull Fractures Intracranial Bleed
- Epidural Hematoma - Subdural hematoma - Intracerebral Bleed - Sub arrachnoid hemorrhage - Diffuse brain injury

39 Epidural hematoma

40 Subdural Hematoma

41 Intracerebral Bleed



44 Management Mild Hi(GCS 13-15) - Neuro-observation
- CT scan if LOC >5 mins Amnesia Severe headache Focal neurological deficit Moderate (GCS 9-13) - CT brain - Admit and observe neurosigns/ FU CT in hrs

45 Severe head injury Prompt diagnosis & treatment
Do not delay patient’s transfer to obtain CT scan!!! Inform the Neurosurgery team and Neurology team on call as required. Intubate if indicted by the ABG’s and clinical signs. Transfer patient to OR or ICU ASAP.

46 Exposure and environment
Aims Remove clothing to allow examination of entire patient Care when removing tight trousers Prevent hypothermia Patient dignity Remove spine board Prevent hypothermia Cover over Warming devices Room temperature Worse if spinal injury

47 Don’t Forget The Back

48 Pause & check Are all immediately life-threatening injuries identified? Is all monitoring in place? Investigations ordered? Analgesia? Relatives informed? Non-essential team members disbanded? Ensure all monitoring in place ECG, BP, SpO2, etCO2, urine output Tests: Chest and pelvic x-rays Ultrasound CT FBC, U&Es, BS, cross-match, pregnancy test, arterial blood gases

49 The well practiced trauma team should aim to complete the primary survey in less than 10 minutes
Illinois EMSC

50 Adjuncts Once the patient is stabilized the patient is sent to radiology for the survey: Cervical spine X-ray (AP and lateral view) Chest X- ray (Rib cage) Pelvis X-ray Abdomen and Pelvis U/S CT brain is ordered if there is suspicion of head trauma X-ray of extremities if fracture is suspected.

51 Don’t forget medical aspects of trauma
Judicious fluid management Adequate and appropriate antibiotic coverage. Proper pain management. Continued vitals monitoring.

52 Secondary Survey Not to begin until primary survey is complete
History (AMPLE) - Allergies - Medications - Past illnesses/ Pregnanacy - Last meal - Events Head-to-toe examination GCS X-rays Specialized diagnostic tests (CT,MRI,Endoscopy)

53 Abdominal trauma Mechanism of injury - Blunt - Penetrating
History and Physical examination - inspection, palpation, percussion and auscultation - Evaluation of penetrating wound - Pelvic stability - Penile, perineal and gluetal examination - vaginal and rectal examination

54 Diagnostic Studies DPL: diagnostic peritoneal lavage FAST
CT scan Abdomen/Pelvis Urethrography, Cystography MRI/MRA

55 Recommendations All Trauma patients should be assessed using the universal AcBCDE approach. Management of Poly-trauma should include primary and secondary survey. Team work is standard in management of trauma patient. High index of suspicion should be kept for aortic trauma in any posttraumatic chest pain.



Download ppt "Approach to poly-trauma patient"

Similar presentations

Ads by Google