Trauma care

Dr. Liu Baochi

Emergency Center
First Affiliated Hospital
Zhengzhou University
Death and taxes are the
two most quoted inevitabilities
of life;
trauma qualifies as a
legitimate third.
—Alexander J.
Walt.
 Trauma Overview
About 3,500,000 died of trauma each
year in the world.

104,000 died of road traffic accident

in 2003 in China.

Trauma is the leading cause of death

among the aged 1~44.
Death are only the tip of the injury iceberg

Deaths
147,891

Hospital discharges
2,591,000

Emergency department visits 36,961,000

1995 in U.S.A
 Emergency Medical
Service System (EMSS)
 Communications: A
reliable communication
system is essential for
providing optimal
trauma care.
 Transport: Equipped
ambulance, helicopter.
 Special trained
prehospital care team.
 Building up the emergency care system

 Command

 Network of EDs

 Team of staff

 Facilities
City of Zheng Zhou 2003~2005 Ambulance dispatch
Attendances 2003 年 2004 年 2005 年
MVA 6114 7210 6907
Other trauma 9020 11468 12390
Burn 125 130 134
Other surgical problems 955 2663 1214
CVS disease 5467 7155 8174
Other medical illness 6439 7079 8253
Poisoning, drowning 3605 3737 4166
O&G 581 814 988
Pediatrics 598 750 696
ENT/eye 66 184 132
Infectious disease 51 56 77
PUO 1910

Total 34931 41246 43131

 Three rings consist of life
chain

Pre-hospital
Emergency
care E ICU
department
Time is life
 Response
. time
。
5 kilometer to scene

Dispatch 1~3 minutes

Arrive to scene 8 minutes

Basic Trauma Life Support
A: Airway maintenance with cervical
spine protection.

B: Breathing and ventilation.

C: Circulation with hemorrhage

control.
Assessment By ‘CRASHPLAN’
 CIRCULATION
 RESPIRATION
 ABDOMEN
 SPINE
 HEAD
 PELVIS
 LIMBS
 ARTERIES
 NERVES
 Pre-hospital Care
 Rapid assessment.
 Appropriate airway management.
 Control of external hemorrhage.
 Stabilization of fractures.
 Rapid transport to the closest appropriate facility (Trauma
Center).
 These centers should have an in-house trauma team
including surgeons and operation room staff.
 triage
1 very severe injury, need
emergency operation.
2 severe, need operation but can
wait a while.
3 slight injury, needn’t admit.
4 dieing, rarely survive.
 medical direction
Senior doctor in field as medical direction.
 Field guideline for triage, treatment,
transport .
four basic technic of
trauma care
Control
bleeding

Bandage up

Fixation

Transport
Control bleeding
1.Press control bleeding:
press by fingers: surface blood
vessels

press by bandage:

filled and depressed by gauze:

limbs canalization.
 2.Control bleeding by
belting
 utility to: Limbs bleeding.

 position:up1/3 of legs or arms .

 material: plastic belt, air belt, cotton

shirting.
Cautions in belting
 1.wire,fine tie can’t be used.
 2.add pads, don’t too tight.
 3.relaxation two minutes after belted
every hour.
Bandage up
Head injury bandage up
Bandage up with triangle
Face injury bandage up
Bandage up singe eye injury
bandage up two eyes
An arm injury bandage up
 notice
 Foreign body—don’t remove

 Injury outside organ—don’t put

inside

 Ear or nose leak —don’t block

Transport patient with foreign
body in the eye
A knife pierce through the neck
A knife in the skull
 Aim of fixation
1. Avoid second injuries
2. Reduce pain
3. Transport easily
Fixation of arm injury
Fixation of leg injury
Fixation of spinal injury
Fixation practice in Hongkong
 transport
 Transport more severe injury first.
 Observe the vital signs.
 Keep breath normal.
 Keep warm and calm.
 Record changeable conditions.
Monitoring during transport
Doctor’s computer
Smart card
Advanced trauma life support
in hospital
Advanced Trauma life Support
 Emergency center: definitive trauma
care.
 Secondary survey: inquiry of
patient’s history and examination.
After initial resuscitation and
re-evaluation of the vital functions .
 History
The history of the injury event is often
unavailable. The patient may be unconscious,
may be impaired secondary to alcohol or other
drug ingestion, or simply be confused.
Remember ‘AMPLE’
A: Allergies. M: Medications currently being
taken by the patients. P: Past illness and
operations. L: Last meal E:
Events/Environment related to the injury.
 Examination
 Neurological assessment: GCS score.
 Neck: X-ray series of cervical spine and CT
scanning of areas in question.
 Chest: Shortness of breath, pain, and
tenderness to direct palpation suggest soft
tissue injury or rib fractures.
 Abdomen: Physical examination and CT
scanning, ultrasound, and other tests.
 Musculoskeletal and peripheral vascular
assessment.
Definitive Trauma Care
 Emergency green route: physical
examination, laboratory tests, X-ray,
ultrasound and other investigations
can be done as soon as possible.
 Resuscitation from hemorrhagic
shock: Reversal of hypovolemia and
control of hemorrhage.
 Emergency operation.
 Damage control surgery
 simple operation to
control bleeding and
contamination
 emergency ICU
 definitive operation
after vital signs being
stable
 Pelvic fracture with traumatic shock

1.Bleeder ligatured

2.Bangage press

3.Withdraw bandage
Case 2
male ， 21 years 。 Severe multiple
injury with traumatic shock. Multiple
limb fracture with blood thorax.
Fracture and dislocation of lumber 3
with ruptured duodenum. Emergency
operation of repair duodenal perforation
and both thorax drainage was done.
ventilation for 8 days after operation and
vital signs became stable . Lumber vertebral
fixation was performed after 40 days.
fracture and dislocation of L3
Repair of duodenum
Ventilation after operation
Case 3
Male,22 years old. Open
abdomen injury and severe right
arm injury with traumatic shock.
Emergency operation of colon
reparation, amputation of right
arm and skin grafting of right
arm to the abdomen had been
done. Patient recovered
successfully.
严重多发伤创伤性休克急诊入院
Multi-injury and traumatic shock
 开放性腹部损伤并腹壁缺损
large area of open abdominal injury and skin loss
 合并右上肢严重挤压伤
right upper limb crush injury
Seven days after operation
One year after operation
One year after operation
Daping coal mine “10.20” injured
Complex
Complex
injury
injury due
due
to
to gas
gas
explosion
explosion
 Remove
Remove
necrosis
necrosis
tissue
tissue and
and
suture
suture

debridement
After operation
Severe contaminated wound healed
All the 32 cases survive
Male,39. severe face injury
Multiple fracture
Debridement and suture
One day after operation
 critical care
 Criticalcare may be defined as the
process of high-frequency physiologic
monitoring coupled with short-response-
time pharmacologic, ventilatory, and
procedural interventions.
 Surgical critical care require intensive
care as the result of an acute surgical
intervention.
ICU
 Summary
 BTLS:A (Airway control)
B (Breathing support)
C (Circulation support)
ATLS: D (Drugs and fluids)
E (Electrocardiography)
F (Fibrillation treatment)
PTLS: G (Gauging, definitive care)
H(Human mentation)
I (Intensive care unite)
liubaochi2002@yahoo.com.cn