polytrauma
DESCRIPTION
polytrauma managementTRANSCRIPT
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Management of
polytrauma patients at
POF Hospital
Dr.Monsif IqbalPGT SU-II
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Summary Case Presentation
• Miss XYZ,a young lady 0f 23
• RTA blunt trauma abdomen
• Patient received in A & E
• Patient then shifted to ITC
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Case presentati
on
Primary Survey
• Pulse….122• BP……..80/55• GCS……15/15• Irritable• pallor• Cold & Clammy
•Grade 3 shock
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Case Presentation
FAST performed
Frank blood in abdominal cavity
Shattered Spleen
FAST
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Management
Resuscitation
Exploratory Laparotomy
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• I/V cannulae • Blood grouping & cross match• Restoration of intra vascular volume• catheterization• antibiotic • Blood transfusion
Case PresentationResuscitation
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Cont. Case Presentation
Patient rushed to OT collapsed on OT table
Successful CPR doneblood transfusion
Patient reverted back
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management
EXPLORATORY LAPAROTOMY
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Findings of exploratory laparotomy Case Presentation
• Splenic injury ….grade 5• Renal injury…….grade 4• Lt colon crushed• Abdominal cavity full of blood• Retroperitoneal hematoma
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Findings of exploratory laparotomyDefinitive surgical treatment Case Presentation
• Splenetomy• Nephrectomy
Lt• Sigmoid
Colostomy
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• Mechanicl vent for 2 days• Drain output gradually reduced• Pneumovac given• Patient went into DIC with deranged
PT & APTT• FFPs and platelets transfused• 7 blood transfusions done gradually • Stoma started working on 2nd POD
Post op recovery
management
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• Patient gradually reovered• Urine output remained satistory• Wound….healthy• Stitches out on 11th POD• Patient discharged home on 13th
POD
Cont…..manageme
nt
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Diagnosis
Management of polytrauma patients
Resuscitation &
definitive management
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• Primary survey• Resuscitation• Secondary
survey• Definitive
management
Componenets ATLS
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•A..airway & cervical spine care
•B…Breathing & ventilation
•C…circulation & hemorrhage control
•D…Deformity & disability
•E…exposure & environmental cond
Primary survey ATLS
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• ECG• Urinary & Gastric catheters• ABGs• Pulse oximetry• X-rays & Diagnostic studies
Adjuncts to primary survey ATLS
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•History Blunt ? Penetrating ? Burn or cold
injuries
•Examination Head & neck Chest Abdomen Extremities spine
Secondary survey ATLS
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• Detailed X-rays• CT scan• Angiography• USG• Transportation
Adjuncts to secondary survey
ATLS
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Abdominal trauma
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Blunt Abdominal trauma
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Penetrating Abdominal trauma
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Laparotomy
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• FAST examines four areas for free fluid:– Morrison’s
Pouch– Perisplenic – Pelvis – +/-Pericardium
Focused Assessment with Sonography in Trauma FAST
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Morrison’s pouch
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• As a decision making tool for identifying the need for laparotomy in hypotensive patients (Systolic BP < 90), FAST has:
• a sensitivity of 92%, • specificity of 96% • Accuracy 93%
• How good is FAST?
How good is FAST? FAST
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DPL
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• Spleen• Kidney• Liver• Intestine• Diaphragm• Pancreas
Specific injuriesPolytrau
ma
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Spleen
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Liver
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• Push• Plug• Pack• pringle
Liver injuriesmanagem
ent
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Kidney
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Grades of renal injury
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Pancreas
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Intestine
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Damage control surgery
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Colon
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Diaphragmatic injury
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Statistics of trauma in POF HOspital from
jan 2010- jan2011
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• Head injury….212• Blunt abdominal injury….67• Penetrating abdominal injury….17• Thoracic injury……27• Orthopedic inj…..89• Polytrauma …..56• Mortality…..24
statistics polytrauma
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ortho
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Managementof Abdominal trauma
Blunt abdominal trauma
Conservative
management
Operative manageme
nt
34 33
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• Total…..57• Positive……30• Inconclusive…..11• Negative……16
FAST done….polytraum
a
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Head injury
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Mortality
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Take home message
‘Multidisciplinary approach required for management of polytrauma patient involving general surgeon,urlogist,orthpedic surgeon,anesthetist,radiologist etc’
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