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səhifə | 8/11 | tarix | 02.01.2022 | ölçüsü | 140,5 Kb. | | #1538 |
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Pitfalls :
Exposure / Environment Control
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Completely undressed the patient.
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Prevent hypothermia
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Injured patients may arrive in hypothermic condition
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Log-roll
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TREATMENT PRIORITY
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NECCESSARY PROCEDURE
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Airway
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Jaw thrust/chin lift/
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Suction
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Intubation
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Cricothyroidotomy
( with protection of C-spine )
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Breathing/Ventilation/oxygenation
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Chest needle decompression
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Tube thoracostomy
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Supplemental oxygen
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Seal open pneumothorax
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Circulation/hemorrhage control
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IV line/ central line
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Venous cutdown
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Fluid resuscitation/Blood transfusion
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Thorocostomy for massive hemothorax
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Pericardiocentesis for cardiac tamponade
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Disability
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Burr holes for trans-tentorial herniation
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IV mannitol
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Exposure/Environment
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Warmed crystalloid fluid
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Temperature
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Electrocardiographic Monitoring.
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Diagnostic peritoneal lavage
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Abdominal ultrasonography (FAST)
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CONSIDER NEED FOR PATIENT TRANSFER
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The secondary survey does not begin until:
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the primary survey is completed,
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resuscitation efforts are well established,
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the patient is demonstrating normalization of vital functions.
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Head-to-toe evaluation
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Complete history and PE
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Reassessment of all vital signs.
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Complete NE.
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Indicated x-rays are obtained.
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Special procedures
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Tubes and fingers in every orifice
AMPLE history
Allergies
Medications currently used
Past illness/ Pregnancy
Last meal
Events/ Environment related to the injury
Mechanism/blunt/penetrating/burns/cold/hazardous environment
Table 1.
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Facial edema in patients with massive facial injury or patients in coma can preclude a complete eye examination.
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Blunt injury to the neck may produce injuries in which clinical signs and symptoms develop late.(e.g. Injury to the intima of the carotid a.)
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The identification of cervical n. root/brachial plexus injury may not be possible in the comatose patient.
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Decubitus ulcer from immobilization on a rigid spine board/cervical collar.
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Children often sustain significant injury to the intrathoracic structures without evidence of thoracic skeletal trauma.
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A normal initial examination of the abdomen does not exclude a significant intraabdominal injury.
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Patients with impaired sensorium secondary to alcohol/drugs are at risk.
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Injury to the retroperitoneal organs may be difficult to identify.
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Female urethral injury are difficult to detect.
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Blood loss from pelvic fractures can be difficult to control and fatal hemorrhage may result.
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Fractures involving the bones of extremities are often not diagnosed.
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Most of the diagnostic and therapeutic maneuvers increase ICP.
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