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W1L1 - Initial Assessment For Trauma - 2

The document outlines the initial assessment and management of severely injured patients according to the Advanced Trauma Life Support (ATLS) protocol. It describes conducting a primary survey to identify and treat life-threatening conditions such as airway obstruction, breathing problems, and hemorrhage. This is followed by a secondary survey and head-to-toe examination to find all injuries and develop a treatment plan. Definitive care is then provided after stabilizing the patient and preparing for safe transfer.

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Baihaqi Saharun
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188 views

W1L1 - Initial Assessment For Trauma - 2

The document outlines the initial assessment and management of severely injured patients according to the Advanced Trauma Life Support (ATLS) protocol. It describes conducting a primary survey to identify and treat life-threatening conditions such as airway obstruction, breathing problems, and hemorrhage. This is followed by a secondary survey and head-to-toe examination to find all injuries and develop a treatment plan. Definitive care is then provided after stabilizing the patient and preparing for safe transfer.

Uploaded by

Baihaqi Saharun
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Initial assessment and management of the severely injured patient

By Dr. Ahmed Negm Ass. Professor of general surgery Mansoura university

Introduction Preparation: pre-hospital & hospital phases

outline

Triage:

Primary survey (ABCDEs) & resuscitation


*adjuncts to primary survey

Secondary survey ( head to toe evaluation and


patient history) *adjuncts to secondary survey

Definitive care

Introduction
Trauma is the leading

cause of death for individuals of age 1-44 years 3rd cause in all ages For every trauma death, 2 people suffer permanent disabilities

Mechanism of injury
Penetrating injuries
Low velocity High velocity

Blunt injuries
Direct Indirect

Acceleration injury

Preparation (prehospital phase)


The prehospital system should notify

the receiving hospital This allows for preparation of trauma team & resources in emergency department Emphasis should be placed on: airway maintenance control of external bleeding immobilization immediate transport

Preparation (hospital phase)


Protect myself
Prepare equipments
Pre-hospital information Nature & time of incident Number, age & gender Injuries identified Treatment given Initial & current vital signs

Triage
Multiple casusalties
The number of patients & severity of there injuries do not

exceed the capability & facility of the hospital


Patients with life threatening problems are treated first.

Mass casualties
The number of patients & severity of there injuries exceeds the capability & facility Patients having the greatest chance of survival and requiring the least facilities are treated first

Advanced Trauma Life Support (ATLS) PROTOCOL :


1. Primary survey/resuscitation
2. Secondary survey 3. Definitive treatment of individual

injuries

I. primary survey & resuscitation


objective To IDENTIFY out and TREAT all IMMEDIATELY life threatening conditions To follow a systematic approach, reflecting the order which if untreated would lead to the patients death

Primary survey & resuscitation Steps

Airway maintenance with cervical spine protection Breathing and ventilation Circulation & control of haemorrhage Disability: neurogenic status Exposure & environmental control: completely
undress the patient, but prevent hypothermia

What is a quick, simple way to assess a patient in 10 seconds?

Primary survey & resuscitation

Same priorities for all patients


Specific considerations for: Elderly Children Pregnancy

Airway with cervical spine control


Aims Assess Clear and secure Provide oxygen

Prevent secondary neurological damage to the spine

Airway assessment (Look, Listen & Feel)


If the patient is capable of unstrained speech, his

airway is patent All patients receive supplemental oxygen by mask upon arrival Clinical clues Noisy breathing Respiratory effort Silence Trauma to the face or head Burns: inhalational injury

Airway interventions
Clear airway
Vomitus, blood or foreign material

Support
Manual: chin-lift or jaw-thrust Oro-pharyngeal airway

Oxygen
Reservoir mask High flow

Monitor
SpO2 End tidal CO2

with C spine control

Tracheal intubation
Apnea Inhalation injuries Closed head injuries(GCS OF 8

or less) Risk of aspiration *Inline immobilization technique

Crico-thyroidotomy
Percutaneous insertion of wide bore needle

Cervical spine control


Clinical clues
Cervical tenderness
Maxillofacial trauma Neurological signs Unconsciousness

Cervical spine immobilization


Rigid neck collar Radiological evaluation Done after stabilization of vital

systems Lateral x-ray film

5 Chest clues in the neck


Wounds Distended neck veins Tracheal position Surgical emphysema Laryngeal crepitus

Breathing and ventilation


Aims Support if inadequate Eliminate any immediately life threatening thoracic condition ..

Breathing and ventilation assessment


Inspection Respiratory rate, effort Symmetry Wounds & marks Palpation Mid axilla Anterior Percussion Mid axilla Above & below nipple line Auscultation Mid axilla Above & below nipple line Check the back

life threatening thoracic conditions


Tension pneumothorax
Open pneumothorax Massive haemothorax Flail chest with pulmonary contusion Cardiac tamponade

Breathing and ventilation


Intubated & ventilated: Position/length of tracheal tube Tidal volume, rate FiO2, eTCO2, SpO2 Peak inflation pressure Feel
Symmetry of movement

Percussion

Listen

Circulation & control of haemorrhage


shock 1. Hemorrhagic 2. Cardiogenic 3. neurogenic

Action
Control bleeding
Insert 2 large bore cannulas (central line may be needed) Blood sample: for typing, cross matching, HB, HTC Ringer lactate infusion (a bolus of 1-2 L ) Monitor urine output (0.5-1 ml/kg/hour)

Bleeding
External bleeding is managed by
Major areas of internal hemorrhage To identify the source

Management of internal hemorrhage

Disability (neurologic evaluation)


Aims Rapid neurological assessment
Alert; Voice; Pain;

Unresponsive Pupils

Mini-neurological

assessment
GCS score
Pupils Lateralising signs

Exposure and environment


Aims Remove clothing to allow examination of entire patient Care when removing tight trousers Prevent hypothermia Remove spine board (unless patient transfer is considered)

Adjuncts to primary survey & resuscitation


ECG
Urinary catheter (unless uretheral injury is suspected) ABG Pulse oximetry X-ray chest & pelvis FAST & DPL

Pause & check


Are all immediately life-

threatening injuries identified?


Is all monitoring in place? Investigations ordered? Analgesia? Relatives informed? Non-essential team members

disbanded?

II. Secondary survey


Only proceed if the life threatening conditions have been corrected

Secondary survey
Aims AMPLE history Examine head to toe, front and back Analyze all clinical, images & lab data Identify all injuries Develop a definitive care plan

Monitor continuously for immediately life threatening conditions

Secondary survey (history)


Allergies

Medications Pre existing medical conditions Last meal Events & Environment
*Mechanism of injury: (pre-hospital personnel)

Secondary survey ( examination)


The back
4 person technique
Examination Remove debris Remove spine board

Dermatomes Myotomes

Secondary survey
Analgesia
Psychological
Fear, sadness, worry

Physical
Splinting, cooling, cover

Pharmacological
Opioids NSAIDs Local anaesthesia Entonox

Preparation for safe transfer


ACCEPT
A Assessment C Command & control C Communication

E Evaluate
P Prepare & Package T Transfer

Wash & brush up!

Reevaluation

Definitive care

Team function & organisation


Function:
Identify and treat life

threatening injuries Identify any other problems Arrange appropriate treatment and investigations Arrange and transfer to definitive care

Organisation: Task allocation Simultaneous activity

Team structureAirway and function


Recorder Breathing

Circulation

Circulation

Radiographer Team leaders Relatives

Any questions?

Summary
Primary survey & resuscitation: recognize and

treat immediately life threatening conditions Secondary survey: identify & prioritize other injuries The basic principles of safe transfer of a patient to definitive care

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