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Initial Assessment and Management

The document discusses the initial assessment and management of trauma patients. It covers conducting a primary survey to address life threats and resuscitation, followed by a detailed secondary survey. Special considerations are given to different patient populations and proper documentation.

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Anonymous PSsXZIhnA
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89 views

Initial Assessment and Management

The document discusses the initial assessment and management of trauma patients. It covers conducting a primary survey to address life threats and resuscitation, followed by a detailed secondary survey. Special considerations are given to different patient populations and proper documentation.

Uploaded by

Anonymous PSsXZIhnA
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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ACS

Initial Assessment
and
Management

ACS

Objectives

Indentify Management Priorities.


Apply principles of primary and
secondary survey.
Institute appropriate resuscitation and
monitoring.
Recognize value of patients history and
biomechanics of injury.
Anticipate pitfalls.

ACS

Concepts of Initial Assessment

Rapid Primary survey


Resuscitation
Adjuncts to primary survey /resuscitation
Detailed secondary survey
Adjuncts to secondary survey
Reevaluation
Definitive care

Initial Assessment
Primary survey and
resuscitation of vital
functions are done
simultaneously
a team approach

ACS

ACS

Preparation
Prehospital System

Transport guidelines /protocols


On-line medical direction
Mobilization of resources
Periodic review of care
Closest appropriate facility

ACS

Preparation
Inhospital

Preplanning essential
Equipment, personnel, services
Standard precautions
Transfer agreement

Standard Precautions

Cap
Gown
Gloves
Mask
Shoe covers
Goggles/face
Shields

ACS

ACS

Triage
Sorting of patients according to :
ABCDEs
Available resources
Multiple casualties
Mass casualties

Primary Survey
Adult, children, pregnant women
Priorities are the same !
A
Airway with c-spine protection
B
Breathing
C
Circulation with hemorrhage control
D
Disability
E
Exposure/Environment

ACS

ACS

Special Considerations
Trauma in the Elderly
5th leading cause of death
Physiologic reserve
Comorbidities : Diseases/medications
Outcome depends on early, aggressive
care

ACS

Primary Survey
Establish Patent Airway
C-spine injury
Pitfalls
Caution

Equipment failure
Inability to intubate
Occult airway injury
Progressive loss of airway

Primary Survey
Suspect C-Spine Injury
Spinal protection
C-spine X-ray when appropriate

ACS

Primary Survey

ACS

Breathing

Assess

Oxygenate
Ventilate
Pitfalls
Airway vs ventilation problem ?
Latrogenic pneumothorax /tension
pneumothorax

ACS

Primary Survey
Assessment of Organ Perfusion
Level of consciousness
Skin color and temperature
Pulse rate and character

ACS

Primary Survey
Circulatory Management

Control hemorrhage
Restore volume

Reassess
Pitfalls
Elderly

Caution

Athletes

Children
Medication

ACS

Primary Survey
Disability

Baseline neurologic evaluation


GCS scoring
Pupillary response

Caution

Observe for neurologic


deterioration

ACS

Primary Survey
Exposure / Environment
Completely undress the patient
Prevent hypothermia
Caution

ACS

Resuscitation
Protect and secure airway
Ventilate and oxygenate
Stop the bleeding
Vigorous shock therapy
Protect from hypothermia

Adjuncts to Primary Survey


Vital sign
ECG
Urinary
Output

ABGs
Adjuncts

Pulse
oximeter
and CO

Urinary/gastric catheters
unless contraindicated

ACS

Adjuncts to Primary Survey


Diagnostic Tools
Chest and pelvic
x-ray
DPL
Ultrasound

ACS

Adjuncts to Primary Survey

ACS

Consider Early Transfer


Do not delay transfer for diagnostic tests
Use time before transfer for resuscitation

Reevaluate
Proceed to Secondary Survey After :

Primary survey completed


ABCD Es are reassessed
Vital functions are returning to
normal

ACS

ACS

Secondary Survey

The complete
history and
physical
examination

Secondary Survey
Key Components

History

Physical examination : Head-to-toe

Tubes and finger in every orifice

Complete neuro exam

Special diagnostic tests

Reevaluation

ACS

ACS

Secondary Survey
History
A Allergies
M Medications
P Past Illnesses
L Last meal
E Events/Environment

ACS

Secondary Survey
Mechanisms of Injury

Secondary Survey
Head

Complete neurologic examination

GCS score determination

Comprehensive eye/ear exam


Pitfalls

Unconscious patient

Periorbital edema

Occluded auditory canal

ACS

ACS

Secondary Survey
Maxillofacial

Bony crepitus/stability

Palpable deformity
Pitfalls

Potential airway obstruction


Cribriform plate fracture
Frequently missed injury

ACS

Secondary Survey
Cervical Spine

Palpate for
tenderness

Complete motor/
sensory exams

Reflexes

C-spine imaging

Pitfalls
Altered LOC for
any reason
Other severe ,
painful injury

ACS

Secondary Survey
Neck (soft tissues)

Mechanism : Blunt
vs penetrating

Symptoms : Airway
obstruction ,
hoarseness

Findings :Crepitus
hematoma ,stridor
bruit

Pitfalls
Delayed symptoms
and signs
Progressive airway
obstruction
Occult injuries

ACS

Secondary Survey
Chest

Inspect

Palpate

Percuss

Auscultate

X-ray

Pitfalls
Elderly
Children

ACS

Secondary Survey
Abdominal Evaluation

Blunt trauma

Penetrating trauma

ACS

Secondary Survey
Abdomen

Inspect, auscultate, palpate, and percuss

Reevaluate frequently

Special studies

Pitfalls
Hollow viscus and retroperitoneal injuries
Excessive pelvic manipulation

Secondary Survey
Perineum

Contusions, hematomas,
lacerations, urethral blood

Rectum

Sphincter tone , high riding


prostate pelvic fracture,
rectal wall integrity, blood

Vagina
Pitfalls

Blood lacerations
Urethral injury in women,
pregnancy

ACS

ACS

Secondary Survey
Musculoskeletal : Extreminities

Contusion , deformity

Pain

Perfusion

Peripheral neurovascular status

X- rays as needed

ACS

Secondary Survey
Musculoskeletal : Pelvis

Pain on palpation

Symphysis width

Leg length unequal

Instability

X-rays as needed

ACS

Secondary Survey
Musculoskeletal

Pitfalls

Potential blood loos


Missed fractures
Soft-tissue or ligamentous injury
Occult compartement syndrome (especially
with altered LOC / hypotension)

ACS

Secondary Survey
Neurologic
Spine / Cord
CNS

Frequent reevaluation
Complete motor
Prefent secondary brain
and sensory exams

injury
Imaging as
indicated

Reflexes
Early neurosurgical consultation

ACS

Adjuncts to Secondary Survey

Special diagnostic test as indicated


Pitfalls
Patient deterioration
Delay of transfer

ACS

Secondary Survey
Neurologic
Pitfalls
Incomplete immobilization
Suble in ICP with manipulation
Rapid deterioration

Reevaluation

ACS

Minimizing Missed Injuries


High index of suspicion
Frequent reeveluation and monitoring

ACS

Reevaluation
Pain Management
Relief of pain /anxiety as appropriate
Administer intravenously
Careful monitoring is essential

Definitive Care

ACS

Local Facility
??
Transfer agreements
?? Local resources ??
??
Trauma
Center

Specialty
Facility

ACS

Record , Legal Considerations


Concise, chronologic documentation
Consent for treatment
Forensic evidence

ACS

Questions

ACS

Summary
Primary Survey

Resuscitation
Adjuncts
Secondary Survey
Adjuncts
Definitive care

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