polytrauma

POLYTRAUMA WITH AIRWAY AND

CIRCULATORY PROBLEMS

Dr. Mansoor KhanMBBS, FCPS I,

Resident, Surgical “C”, KTHPeshawar.

Sep 29th, 2009

“ Trauma to two or more than two systems of the body with

associated signs and symptoms ”

Within minutes

Within Hours

(Golden Hour)

Within

Days or weeks

Major Vascular/neurological Trauma Medical treatment usually

not helpful

Intracranial hematoma, major Thoracic/abdominal

trauma

Due to sepsis &

multi organ failure

M

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Triage 'do the most for the most'

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Cat Definition Colour Treatment Example

P1 Life-Threatening

Red Immediate Tension Pneumothorax

P2 Urgent Yellow Urgent Fracture femur

P3 Minor Green Delayed Sprained ankle

P4 Dead White

TRIAGE

Walk Airway Respiratory rate Pulse rate or Capillary return

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Triage 2

Primary survey and resuscitation

A = Airway and cervical spine B = Breathing C = Circulation and haemorrhage control D = Dysfunction of the central nervous system E = Exposure

Secondary survey

Definitive treatment

Call for help

ASSESSMENt

Always assume cervical spine injury

If patient can talk then no airway problem

If airway compromised initially attempt a chin lift and clear airway of foreign bodies

Intubate or cricothyroidotomy Give 100% Oxygen

Airway and cervical spine

Airway

OROPHYRINGEAL AIRWAY

Choking

ENDOTRACHEAL INTUBATION

LMA

Check position of trachea, respiratory rate and air entryTension pneumothorax will need immediate relief Place venous cannula through second intercostal space in the mid-clavicular line

If open chest wound seal with occlusive dressing

BREATHING

PNEUMOTHORAX

FLAIL CHEST

EMERGENCY DECOMPRESSION

EMERGENCY DECOMPRESSION

CHEST DRAIN

OCCLUSIVE CHEST DRESSING

Assess pulse, capillary return and state of neck veins Identify exsanguinating haemorrhage and apply direct pressure

Place two large calibre intravenous cannulas Give intravenous fluids (crystalloid or colloid)Attach patient to ECG monitor

Circulation and haemorrhage control

Bleeding from hand

BLEEDING CONTROL FROM ARM

BLEEDING CONTROL FROM GROIN

Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive

Assess pupil size, equality and responsiveness

Dysfunction

Avoid hypothermia

Fully undress patients Avoid hypothermia

Exposure

Check all causalities

Quick assessNo moving

Apply life-saving treatment

Treat

in the position foundfirst life-threatening or

potentially serious injuries

THANKS