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Objectives
Case presentation on poly-trauma
patient.
Discussion on the case
Approach to poly-trauma patient
Recommendation
MCQ
Case
Male patient 28 years presented to the ER
On examination
Airway: Clear
Cervical Spine immobilization after neck
Circulation:
There is no major site of bleeding, vital signs include:
HR: 100/min felt central and peripheral, equal on
both sides.
Blood pressure: 100/60 mmHg.
Capillary refill time: 1.5 sec.
Temp: 37.1C
Neck veins not congested
There is wound in the forehead 5X3 cm.
Disability
GCS 15/15
No loss of cons, no nausea or vomiting, no bleeding
Exposure
No major bleeding
No major deformity
Discussion on part
one of the lecture
Types of assessment
1. Primary Survey and resuscitation
Identification of Life threatening
conditions
ACBCDE Approach
2. Secondary Survey
Detailed head to toe examination
Medical history
All lab and radiology investigation
ordered
emergencies
Assess Change - Reassess
THREATENING
Initiation of LIFE-SAVING
measures (CPR)
Illinois EMSC
5 second Round
Pt is conscious or not
Airway
Ventilation
Signs of massive external
hemorrhage
There is any deformity
Skin color and temp with feeling
Illinois EMSC
10
Primary Survey
Airway/
11
Assessing Airway
Is the airway:
AIRWAY INTERVENTIONS
Jaw thrust Vs Head tilt.
Deliver Oxygen (mask
with reservoir).
Use Rigid suction.
Secure airway.
Illinois EMSC
13
veins
Tracheal
position
Surgical
emphysema
Laryngeal
crepitus
of the head
cervical collar.flv
manual in line
stabilization
Illinois EMSC
15
Breathing and
ventilation
Aims
Support if
inadequate
Eliminate any
immediately life
threatening
thoracic
condition ..
Breathing and
ventilation
Inspection
Respiratory rate
Effort of breathing
Symmetry
Wounds & marks
Palpation
Tender points, equal
expansion
Percussion
No abnormal note
Auscultation
All lung zones
BREATHING INTERVENTIONS
If breathing is absent, start
ventilation using:
Simple Adjuvants (Airways)
Bag valve mask with reservoir
LMA
ETT
Illinois EMSC
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19
CIRCULATORY ASSESSMENT
Carotid pulse (absent or
present)
Capillary refill
Skin color
Skin temperature
Sites of bleeding
Illinois EMSC
20
CIRCULATORY INTERVENTIONS
If central pulse is absent, begin
CPR
Apply direct pressure to open
wounds
IV access (2 wide bore
cannulae14/16G).
Fluids (colloids Vs crystalloids) 20ml/Kg
Dysfunction of the
CNS
Aims
Rapid neurological
assessment
Alert; Voice; Pain;
Unresponsive
Pupils
Mini-neurological
assessment
GCS score / AVPU
Pupils
Lateralising signs
Blood sugar
23
Exposure and
environment
Aims
entire patient
Care when removing tight trousers
Prevent hypothermia
Patient dignity
Remove spine board
life-threatening
injuries identified?
Is all monitoring in
place?
Investigations
ordered?
Analgesia?
Relatives informed?
Non-essential team
members disbanded?
Illinois EMSC
27
Radiology
Once the patient is stabilized the patient is
head trauma
X-ray of extremities if fracture is suspected.
Chest X-Ray
Part 2 case
Patient returned form the radiology
Pethedine 50 mg IM
p
e
t
s
t
x
e
n
e
h
t
s
i
t
a
h
W
Chest X-Ray
Mediastinal widening
Double aortic knob sign
Diffuse enlargement of the aorta
Tracheal displacement to the right
Pleural effusion
CT chest
Aortograghy
Aortograghy
Final Diagnosis
Traumatic aortic tear
THORACIC
TRAUMA
include:
Severe retrosternal pain
Pain between the scapulae
Hoarseness of voice (pressure from
MANAGEMENT OPEN
PNEUMOTHORAX
Ensure adequate
airway
100% oxygen
Seal open wound
Load & Go
IV access en route
Notify Medical
Direction
Courtesy of David
Effron, M.D.
TENSION
PNEUMOTHORAX
MANAGEMENT
TENSION PNEUMOTHORAX
Ensure adequate airway
100% oxygen
Needle decompression if indicated
Load & Go
IV access en route
Notify Medical Direction
MCQ
1. Which of the following is true in regards to a
Recommendations
All Trauma patients should be assessed using the
secondary survey.
Team work is standard in management of trauma
patients.
Routine investigation should be implemented as a
QUESTIONS?
THANK YOU