trauma case presentations - ucsf cme - dicker... · trauma case presentations. case #1 ems report:...
TRANSCRIPT
![Page 1: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/1.jpg)
Trauma Case Trauma Case PresentationsPresentations
![Page 2: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/2.jpg)
Case #1Case #1EMS Report:EMS Report:–– 26 year26 year--old man shot multiple timesold man shot multiple times–– Vomited with probable aspiration en routeVomited with probable aspiration en route–– Vitals upon arrival to trauma bayVitals upon arrival to trauma bay
90/P, HR 120, RR 3090/P, HR 120, RR 30
–– WorkupWorkup--Primary surveyPrimary surveyAirway intactAirway intactDistant but audible bilateral breath soundsDistant but audible bilateral breath soundsSecond vitals: 85/P, HR 120, RR 30Second vitals: 85/P, HR 120, RR 30ABG: 7.25/30/120/ ABG: 7.25/30/120/ --1414
![Page 3: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/3.jpg)
Case #1: Secondary surveyCase #1: Secondary survey
Lethargic but arousableLethargic but arousableGun shot wounds as Gun shot wounds as shownshownMoves all extremitiesMoves all extremitiesBleeding from GSW at Bleeding from GSW at inguinal ligamentinguinal ligamentPulseless RLEPulseless RLE
![Page 4: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/4.jpg)
Case #1Case #1--ManagementManagement
AirwayAirwayIV accessIV accessRadiologic studiesRadiologic studiesBlood workBlood workNext set of vitals: 70/P, HR 140, RR 30Next set of vitals: 70/P, HR 140, RR 30Resuscitation Resuscitation
![Page 5: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/5.jpg)
Radiologic studiesRadiologic studies
![Page 6: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/6.jpg)
Operative ManagementOperative Management
First incisionFirst incision–– Operative proceedings and findingsOperative proceedings and findings–– Resuscitation; blood product ratiosResuscitation; blood product ratios–– Antibiotics ?Antibiotics ?Next moveNext move–– How to manage the How to manage the poplitealpopliteal–– OrthopedicOrthopedic’’ss rolerole
![Page 7: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/7.jpg)
ICU ManagementICU ManagementSedation and ventilation in a patient with Sedation and ventilation in a patient with an open abdomenan open abdomenTiming of operative returnTiming of operative return
![Page 8: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/8.jpg)
Second OperationSecond Operation
Management from AnesthesiaManagement from Anesthesia
Management from SurgeryManagement from Surgery
![Page 9: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/9.jpg)
Follow up careFollow up care
CKCK--40,00040,000–– Workup and managementWorkup and management
RLE vascular imaging choicesRLE vascular imaging choices
![Page 10: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/10.jpg)
Case #2Case #2EMS report: 74 yearEMS report: 74 year--old driver in highold driver in high--speed speed MVCMVC–– Belted, no airbag, + LOCBelted, no airbag, + LOC
Upon arrival to trauma bay:Upon arrival to trauma bay:–– Vitals 130/P, Vitals 130/P, afibafib 100, RR 30100, RR 30–– ABGABG--7.34/42/80 BD7.34/42/80 BD--55
Primary surveyPrimary survey–– Airway; tongue dropping backAirway; tongue dropping back–– Shallow breath sounds R>LShallow breath sounds R>L–– AccessAccess–– GCSGCS--55
![Page 11: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/11.jpg)
RadiologyRadiology
![Page 12: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/12.jpg)
ManagementManagement
ResuscitationResuscitationNext stepsNext steps……..
Chest tube placed, intubationChest tube placed, intubation
![Page 13: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/13.jpg)
Head CTHead CT
![Page 14: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/14.jpg)
Chest CTChest CT
![Page 15: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/15.jpg)
Operative Management:Operative Management: Subdural evacuationSubdural evacuation
Anesthesia PrinciplesAnesthesia Principles
![Page 16: Trauma Case Presentations - UCSF CME - Dicker... · Trauma Case Presentations. Case #1 EMS Report: – –26 year-old man shot multiple times – –Vomited with probable aspiration](https://reader031.vdocument.in/reader031/viewer/2022022510/5adcdedb7f8b9ae1408c2c54/html5/thumbnails/16.jpg)
Management of Traumatic Aortic Management of Traumatic Aortic LacerationLaceration
Endovascular Options?Endovascular Options?In setting of head injury?In setting of head injury?–– Issues with anticoagulationIssues with anticoagulationICU CareICU Care–– Glucose control with head injuryGlucose control with head injury–– Rate control for Rate control for afibafib–– PreopPreop care to limit shear effect of injurycare to limit shear effect of injury