polytrauma
TRANSCRIPT
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
o
R
T
A
L
I
T
y
Triage 'do the most for the most'
T
R
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G
E
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
T
R
I
A
G
E
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