Assesment of Multiple Trauma Patient

Plenary Lecture By Freda S.Halim, SpB Pelita Harapan University 2012

Initial Assesment of Multiple Trauma Patient

Preparation ( prehospital phase, hospital phase )

Triage
Primary Survey + resuscitation
Adjuncts to primary survey and resuscitation : ECG, gastric catheter Consider need for patient transfer

Secondary survey
Adjuncts to secondary survey

Continued postresuscitation monitoring and reevaluation Definitive care

Preparation : Prehospital Phase Every effort should be made to minimize scene

time!

Emphasis should be placed on : airway maintenance, control of external bleeding and shock, immobilization of the patient, immediate transport to the closest appropriate facility/trauma center

Also important : obtaining and reporting information needed for triage at the hospital

Preparation : hospital phase

Triage area Resuscitation area Ready to use equipments Ready healthcare personnels ( doctors,nurses) Ready to call additional medical assistance

Triage
Sorting of patients based on their need for treatment, and the decision regarding to which medical facility they should be transported

Useful in multiple casualties and mass casualties

Primary Survey+Resuscitation
Airway maintenance with cervical spine protection

Breathing and ventilation

Quick, simple way to asses the patient in 10 seconds!

Life threatening conditions are identified, and management is instituted simultaneously!! Prioritized assessment and management are in sequential steps in order of importance!!

Circulation with hemorrhage control

Disability : neurologic status

Exposure

Airway + C-Spine ontrol

Recognition of patient with potency of airway compromiseairway control C-spine control
We do : Cleansing the airwaysuction Jaw thrust, chin-lift Oropharyngeal airway Definitive airway ( endotracheal intubation, tracheostomy C-spine control should be indicated in every multiple trauma patient

Breathing and ventilation

Quick assesment !! :
Inspection :
Freq of the resp rate Chest shape and movement

Percussion : sonor/hipersonor/dull Palpation: crepitation, tenderness Auscultation: normal/decreased VBS

Rib fractures Pneumothorax Hematothorax Hematopneumothorax Flail chest Lung contusion Tension pneumothorax Cardiac tamponade

We do : Oxygenation, portable chest x-ray, chest tube insertion Monitoring the oxygen saturation,ventilatory support

Circulation and Hemorrhage control

Quick assesment !! :
HR Blood pressure Skin perfusion Urine output

Hypovolemic shock Cardiac shock Distributive shock Spinal shock Septic shock

Hypovolemic shock : grade 1,2,3,4 We do : put 2 large bores IV needles,2000cc warmed crystalloid infusion,blood crossmatch,urine catheter insertion, hemorrhage control

Disability : neurological examination

Quick assesment !!
GCS Pupils Neurological exam : motoric and sensoric function

No head injury Mild head injury Moderate head injury Severe head injury

We do : oxygenation, consider intubation in severe head injury, head up, immobilization of the spine

So when we do the history taking?what is important in history taking of multiple trauma patient?
At the same time when the patient is on primary survey and resuscitation
should be quick, practical and organized
Chief complain Onset of trauma! Mechanism of trauma! Injury sustained

Secondary Survey
It is the time for Head-to-toe examination of the trauma patient, combined with complete history and physicial examination.
It is the time for recognizing the less dangerous injury, It is the time to do more sophisticated investigation It is the time to give further treatment for the injury Shouldnt start if the primary survey is not finished or clear!!!

Primary survey

Secondary survey

Continued Postresuscitation Monitoring and Reevaluation

Depends on the trauma type Depends on the facility and equipments provided by the hospital Depends on the ability of the healthcare personnel

Definitive Care
Which patients do i transfer to a higher level of care?when should the transfer occur?

Take Home Message

Multiple traumashould be managed by trauma team Priority of the trauma patient is different than nontrauma patient : all should be quick and organized
History taking, physical examination and immediate treatment come into one package : primary survey!!! Head to toe exam, complete history taking, other sophisticated investigations, further treatments come in secondary survey

Equipped yourself!

Source
Advanced Trauma Life Support, 2008 Feliciano and Moore, Trauma, 2006,6th ed