1. Critically injured patient
Prof Mohan de Silva

4. Essential words to remember
TRIMODAL distribution of deaths
ATLS
Primary survey
Secondary survey

5. The Critically Injured
Trauma
commonest cause of hospital admissions
in Sri Lanka since 1995
commonest cause of death below the
age of 40 in many countries

6. The critically injured
Majority died due to inadequate
treatment
Initial treatment determines the
outcome
Early intervention is essential

7. GOLDEN HOUR OF TRAUMA

8. TRIMODAL DISTRIBUTION OF DEATHS
Immediate
1st few hours
Few days after admission

9. Conventional approach
History
Examination
Investigations
Diagnosis
Treatment

10. How it all started Another accident ………..

11. New approach… A T L S Examination ) Resuscitation ( Treatment )
Initial assessment ( History,
Examination )
Resuscitation ( Treatment )
WILL BEGIN SIMALTANEOUSLY
Recognize and treat the most life
threatening injury first

12. TRAUMA KILLS ACCORDING TO A SEQUENCE !
Acute airway obstruction
- The quickest killer
Inadequate breathing
Hypovolaemia
Expanding intra cranial
haematoma

13. Hypoxia and Hypovolaemia
are the main killers
Hypoxia kills before
hypovolaemia

14. PRIMARY SURVEY
SECONDARY SURVEY

15. Initial assessment and resuscitation Primary survey
A ir way with cervical spine control
B reathing
C irculation
D isability (Neurological )
E xposure
F oleys catheter

16. Airway obstruction recognition and treatment
Identify – SPEAK TO THE PATIENT
establish OXYGEN
protect OXYGEN
maintain OXYGEN
10 L / minute

17. Immobilisation of the C spine
sand bag
collar
tape

18. B reathing Inspection - wall movements,ext.
injuries etc
Palpation cripitus
percussion hyperesonence
or stony dullness
Auscultation - breath sounds
absent
RESPIRATORY RATE

19. Circulation hypovolaemic shock Action PULSE RATE , B P
All critically injured patients are in
hypovolaemic shock Action PULSE RATE , B P
2 Big drips to Two big veins
2 L of N Saline fast in
Blood cross matching

20. Glasgow coma score Expose the patient Where is the scissor ! A V P U
D isability (Neurological )
A V P U
Glasgow coma score
Expose the patient
Where is the scissor !

21. Secondary survey Pulse - BP – RR -Temperature
Systematic examination from head
to toe
LOG ROLL
Finger to all orifices
Minor injuries

22. History A M P L E
A llergies
M edications
P ast illnesses
L ast meal
E vents leading to the injury

23. Outcome ?

24. TAKE HOME MESSAGE
What is the first thing you do when you get a critically injured ?
What is the quickest killer of the injured?
What is trimodal distribution of deaths?
What is the difference between conventional and ATLS approach
What do you do in Primary and secondary surveys?