Presentation on theme: "What is polytrauma Multiple traumatic injuries to a victum."— Presentation transcript:
What is polytrauma Multiple traumatic injuries to a victum.
Overview of ATLS
Types of assessment 4 1.Primary Survey and resuscitation Identification of Life threatening conditions AcBCDE Approach 2.Secondary Survey Detailed head to toe examination Medical history All lab and radiology investigation ordered Management Plan
Illinois EMSC5 PURPOSE OF THE INITIAL ASSESSMENT Identification of LIFE-THREATENING emergencies Assess – Change - Reassess Initiation of LIFE-SAVING measures (CPR)
5 second Round Illinois EMSC6 Pt is conscious or not Airway Ventilation Signs of massive external hemorrhage There is any deformity Skin color and temp with feeling pulse
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
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
Illinois EMSC25 CIRCULATORY ASSESSMENT Carotid pulse (absent or present) Capillary refill Skin color Skin temperature Sites of bleeding
26 CIRCULATORY INTERVENTIONS 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?
Hemorrhagic Shock Most common cause of shock in trauma External vs Internal hemorrhag Blood volume = 7% of BW Rx : Volume replacement Shock classification
Classification Type % blood loss - p<100 - BP Normal - PP Normal - RR Urine output > 30cc/h - Mental status : Slightly anxious
Classification Type % blood loss - p>100 - BP Normal - PP Decreased - RR Urine output 20-30cc/h - Mental status : Mildly anxious
Classification Type % blood loss - p>120 - BP Decreased - PP Decreased - RR Urine output > 5-15cc/h - Mental status : Confused
Classification Type 4 - >40% blood loss - p>140 - BP Decreased - PP Decreased - RR >35 - Urine output Nil - Mental status : Confused/ Lerthargic
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
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
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
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
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.
Exposure and environment Aims Remove clothing to allow examination of entire patient Care when removing tight trousers Prevent hypothermia Patient dignity Remove spine board
Don’t Forget The Back
Pause & check Are all immediately life- threatening injuries identified? Is all monitoring in place? Investigations ordered? Analgesia? Relatives informed? Non-essential team members disbanded?
The well practiced trauma team should aim to complete the primary survey in less than 10 minutes Illinois EMSC49
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.
Don’t forget medical aspects of trauma Judicious fluid management Adequate and appropriate antibiotic coverage. Proper pain management. Continued vitals monitoring.
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)
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
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.