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    Trauma Overview

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    FrancescoBarbero
    The document provides an overview of trauma management. It discusses the trimodal distribution of death in trauma patients, with peaks instantly, within minutes to hours, and days to weeks. The goals of trauma management are to minimize time to care, identify all injuries, and ensure each patient leaves with a clear management plan. The document then details the ABCDE approach to the primary and secondary survey, emphasizing rapid assessment and treatment of airway, breathing, circulation, disability, and exposure issues to save lives and prevent disability.

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    Trauma Overview

    Uploaded by

    FrancescoBarbero
    130 views48 pages
    The document provides an overview of trauma management. It discusses the trimodal distribution of death in trauma patients, with peaks instantly, within minutes to hours, and days to weeks. The goals of trauma management are to minimize time to care, identify all injuries, and ensure each patient leaves with a clear management plan. The document then details the ABCDE approach to the primary and secondary survey, emphasizing rapid assessment and treatment of airway, breathing, circulation, disability, and exposure issues to save lives and prevent disability.

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    In-hospital trauma management (overview)

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    The document provides an overview of trauma management. It discusses the trimodal distribution of death in trauma patients, with peaks instantly, within minutes to hours, and days to weeks. The goals of trauma management are to minimize time to care, identify all injuries, and ensure each patient leaves with a clear management plan. The document then details the ABCDE approach to the primary and secondary survey, emphasizing rapid assessment and treatment of airway, breathing, circulation, disability, and exposure issues to save lives and prevent disability.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    130 views48 pages

    Trauma Overview

    Uploaded by

    FrancescoBarbero
    The document provides an overview of trauma management. It discusses the trimodal distribution of death in trauma patients, with peaks instantly, within minutes to hours, and days to weeks. The goals of trauma management are to minimize time to care, identify all injuries, and ensure each patient leaves with a clear management plan. The document then details the ABCDE approach to the primary and secondary survey, emphasizing rapid assessment and treatment of airway, breathing, circulation, disability, and exposure issues to save lives and prevent disability.

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    OVERVIEW

    ON TRAUMA
    MANAGEMENT
    Francesco Barbero, Crit Care Nurse
    Objectives

    Demonstrate concepts ofprimary and


    secondary patient assessment
    Establish management priorities in trauma
    situations
    Initiate primary and secondary management
    as necessary
    Arrange appropriate disposition
    Who are the trauma pts in your
    hospital?
    Admission
    statistics on
    an US
    Hospital

    The importance of injury as a public health


    Trimodal death distribution

    First peak instantly

    Second peak minutes to hours

    Third peak days to weeks


    Death within mintuses and hours
    Hypoxia
    Bleeding and subsequent postinjury coagulopathy
    Brain
    Death over days
    Sepsis from injured hollow viscus
    Sepsis from nosocomial infections
    Brain
    Organ failure
    Thromboembolic complications
    The management of a trauma patient should
    allow the following aims to be met:
    Minimise the time from injury to definitive care.
    Don't allow the obvious injury to distract you
    from diagnosing other, less obvious injuries.
    No patient should leave the resuscitation area
    without a clear management plan.
    Why ATLS?
    The sequence of goals in the initial assessment of an
    individual trauma patient are:
    Save life. This requires knowledge of the causes
    of death.
    Prevent major disability. This requires knowledge
    of the causes of disability.
    Diagnose and appropriately manage all injuries.
    Avoid unnecessary investigations or
    interventions.
    Concepts of ATLS
    Treat the greatest threat to life first
    The lack of a definitive diagnosis should never
    impede the application of an indicated
    treatment
    A detailed history is not essential to begin the
    evaluation
    ABCDE approach
    Initial Assessment and
    Management
    An effective trauma system needs the
    teamwork of EMS, emergency medicine,
    trauma surgery, and surgery subspecialists
    Trauma roles
    Trauma Leader
    Different specialists
    Nurses
    Recorder
    Trauma Team
    Primary Survey
    Patients are assessed and treatment priorities
    established based on their injuries, vital signs,
    and injury mechanisms
    ABCDEs of trauma care
    A Airway and c-spine protection
    B Breathing and ventilation
    C Circulation with hemorrhage control
    D Disability/Neurologic status
    E Exposure/Environmental control
    Airway
    How do we evaluate the
    airway?
    A- Airway
    Airway should be assessed for patency
    Is the patient able to communicate verbally?
    Inspect for any foreign bodies
    Examine for stridor, hoarseness, gurgling,
    pooled secrecretions or blood
    Assume c-spine injury in patients with
    multisystem trauma
    C-spine clearance is both clinical and
    radiographic
    C-collar should remain in place until patient can
    cooperate with clinical exam
    Airway Interventions
    Supplemental oxygen
    Suction
    Chin lift/jaw thrust
    Oral/nasal airways
    Definitive airways
    RSI for agitated patients with c-spine
    immobilization
    ETI for comatose patients (GCS<8)
    The importance of a plan B
    Breathing
    What can we look for clinically to assess a
    patients breathing status?
    B- Breathing
    Airway patency alone does not ensure
    adequate ventilation
    Observe, palpate, auscultate, count and SpO2
    Deviated trachea, crepitus, flail chest, sucking
    chest wound, absence of breath sounds
    CXR to evaluate lung fields
    Flail Chest
    Subcutaneous
    Emphysema
    Breathing Interventions
    Ventilate with 100% oxygen
    Needle decompression if tension
    pneumothorax suspected
    Chest tubes for pneumothorax / hemothorax
    Occlusive dressing to sucking chest wound
    If intubated, evaluate ETT position
    What would we do for this patient who is having
    difficulty breathing?
    C- Circulation
    Hemorrhagic shock should be assumed in any
    hypotensive trauma patient
    Rapid assessment of hemodynamic status
    Level of consciousness
    Skin color
    Pulses in four extremities
    Blood pressure and pulse pressure
    C- Circulation
    C- Circulation
    Circulation Interventions
    Cardiac monitor
    Apply pressure to sites of external hemorrhage
    Establish IV access
    2 large bore IVs
    Central lines if indicated
    Cardiac tamponade decompression if indicated
    Volume resuscitation
    Have blood ready if needed
    Level One infusers available
    Foley catheter to monitor resuscitation
    S Head trauma= 110
    B Blunt trauma= 90
    P Penetrating trauma= 70
    D- Disability
    Abbreviated neurological exam
    Level of consciousness
    Pupil size and reactivity
    Motor function
    GCS
    Utilized to determine severity of injury
    E- Exposure
    Complete disrobing of patient
    Logroll to inspect back
    Rectal temperature
    Warm blankets/external warming device to
    prevent hypothermia
    Always Inspect the Back
    Secondary Survey
    AMPLE history
    Secondary Survey
    Physical exam from head to toe, including
    rectal exam
    vitals
    Frequent reassessment of
    Complete diagnostic test according to pt
    conditions
    Diagnostic Aids
    Standard trauma labs
    CBC, K, Cr, PTT, Utox, EtOH, ABG
    Cross match and blood type
    Standard trauma radiographs
    CXR, pelvis, lateral C-spine (traditionally)
    FAST scans (or/and CT if available)

    PS: Pt must be always monitored and should only go to radiology if


    stable
    Simple Pneumothorax
    How do you treat
    this?
    Tension Pneumothorax
    Hemothorax
    What should this injury make you worry about?
    Bilateral Pubic Ramus Fractures and
    Sacroiliac Joint Disruption
    Abdominal Trauma
    Common source of traumatic injury
    Mechanism is important
    High suspicion with tachycardia, hypotension,
    and abdominal tenderness
    Can be asymptomatic early on
    FAST exam can be early screening tool
    Abdominal Trauma
    Look for distension, tenderness, seatbelt
    marks, penetrating trauma, retroperitoneal
    ecchymosis
    Be suspicious of free fluid without evidence of
    solid organ injury
    FAST Exam
    Focused Abdominal
    Scanning in Trauma
    4 views: Cardiac, RUQ,
    LUQ, suprapubic
    Goal: evaluate for free
    fluid
    Summary
    Trauma is best managed by a team approach
    (theres no I in trauma)
    A thorough primary and secondary survey is
    key to identify life threatening injuries
    Once a life threatening injury is discovered,
    intervention should not be delayed
    Disposition is determined by the patients
    condition as well as available resources.

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