1. Preparation



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1. Preparation

  • 1. Preparation

  • 2. Triage

  • 3. Primary Survey

  • 4. Resuscitation

  • 5. Secondary Survey

  • 6. Continued postresuscitation monitoring and re-evaluation

  • 7. Definitive care



Prehospital

  • Prehospital

    • Notify receiving hospital
    • Closest appropriate facility
    • Report pertinent information
  • Inhospital

    • Warmed IV solutions
    • Ancillary departments notified
    • Equipment made readily available
    • Hospital personnel protection


Airway

  • Airway

  • Breathing

  • Circulation

  • Disability: Neurologic Evaluation

  • Exposure/Environmental Control



Patency

  • Patency

  • Foreign bodies

  • Facial Fractures

  • Protect C-spine



Patency does not equal adequate ventilation

  • Patency does not equal adequate ventilation

  • Expose chest

  • Auscultate

  • Conditions that may acutely impair ventilation

    • Tension pneumothorax
    • Massive hemothorax
    • Flail chest
    • Rib fractures
    • Open pneumo
    • Pulmonary contusion


Hemorrhage control

  • Hemorrhage control

  • Two Key Elements

  • 1. Level of Consciousness

  • -AVPU

  • -Glasgow Coma Score

  • 2. Pulse



Control

  • Control

  • No hemostats

  • Consider occult sources



AVPU

  • AVPU



Verbal Response Motor response

  • Verbal Response Motor response

  • Oriented 5 Obeys 6

  • Confused 4 Localizes 5

  • Inappropriate words 3 Withdraws 4

  • Incomprehensible sounds 2 Decortication 3

  • None 1 Decerebration 2

  • None 1

  • Eye Opening

  • Spontaneous 4

  • To speech 3

  • To pain 2

  • None 1



Remove all clothes

  • Remove all clothes

  • Cover to prevent hypothermia



Airway

  • Airway

    • Oral
    • Nasal- do not put in someone with facial trauma
    • Endotracheal
    • Surgical
  • Breathing

    • Supply O2
    • Ventilate alveoli


Circulation

  • Circulation

    • Establish 2 large bore IVs
    • Draw blood
    • Vigorous IV therapy
    • ECG monitoring
    • Avoid hypothermia
    • Evaluate PEA
    • Other dysrhythmias




Catheters

  • Catheters

    • Urinary
    • Gastric
      • Oral v.s. nasal placement




Monitoring

  • Monitoring

    • ABG’s
    • Pulse oximetery
    • Blood pressure
    • ECG


Should not delay resuscitation

  • Should not delay resuscitation

  • AP pelvis

  • AP chest

  • Lateral C-spine

  • Odontoid, AP C-spine



FAST scan

  • FAST scan

  • Focused Assessment Sonography in Trauma

    • Ultrasound
      • Pericardial sac (epigastric area)
      • Hepatorenal fossa
      • Splenorenal fossa
      • Pelvis or Pouch of Douglas (bladder)


Head-to toe evaluation

  • Head-to toe evaluation

    • Vital sign evaluation
    • Detailed neuro exam if not done in primary survey
    • Special procedures
  • “Tubes and fingers in every orifice”



A Allergies

  • A Allergies

  • M Medications

  • P Past illnesses

  • L Last meal

  • E Events related to injury

  • 1.Blunt

  • 2.Penetrating

  • 3.Burns

  • 4.Hazardous Environment





A Allergies

  • A Allergies

  • M Medications

  • P Past illnesses

  • L Last meal

  • E Events related to injury

  • 1.Blunt

  • 2.Penetrating

  • 3.Burns

  • 4.Hazardous Environment



Scalp

  • Scalp

  • Eyes

  • Nose

  • Mouth

  • Bite occlusion



PITFALLS

  • PITFALLS

  • Hyphema

  • Optic nerve injury

  • Lens dislocation

  • Head injury

  • Posterior scalp laceration



Midline facial fractures

  • Midline facial fractures

  • Bite occlusion

  • Bleeding

  • Fracture repair can wait



I: Maxilla only transversely above the alveolar ridge

  • I: Maxilla only transversely above the alveolar ridge

  • Most common isolated

  • II (pyramidal): Through nasal bone or nasal bone disarticulation with frontal bone

  • Most common when associated with other fractures

  • III (dislocated face): Through nasal bone, across floor of orbit, through lateral wall of orbit, zygomatic arch Rare





PITFALLS

  • PITFALLS

  • Pending airway obstruction

  • Changes in airway status

  • Cervical spine injury

  • Exsanguinating midface fracture

  • Lacrimal duct lacerations

  • Facial nerve injuries



Must be immobilized

  • Must be immobilized

  • Inspection

  • Palpation

  • Auscultation (carotids)



PITFALLS

  • PITFALLS

  • C-spine injury

  • Esophageal injury

  • Tracheal or laryngeal injury

  • Carotid injury (blunt or penetrating)



Visual evaluation (ant & post)

  • Visual evaluation (ant & post)

  • Palpate rib cage

  • Sternal pressure

  • Auscultation (heart & lungs)

  • Chest xray



PITFALLS

  • PITFALLS

  • Tension pneumothorax

  • Open chest wound

  • Flail chest

  • Cardiac tamponade

  • Aortic rupture (widened mediastinum)











Frequently repeated exams

  • Frequently repeated exams

  • Inspection

  • Palpation

  • Normal initial exam does not rule out injury

  • Peritoneal lavage v.s. CT scan v.s. U/S (FAST)



PITFALLS

  • PITFALLS

  • Liver or splenic flexure

  • Deceleration injuries

  • Hollow viscus, Lumbar spine

  • Pancreatic injury

  • Major intraabdominal vascular injury

  • Renal injury

  • Pelvic fractures



Contusions,Hematomas, Lacerations

  • Contusions,Hematomas, Lacerations

  • Urethral bleeding

  • Rectal blood

  • High riding prostate

  • Sphincter tone

  • Vaginal vault injuries (pelvic fractures)



PITFALLS

  • PITFALLS

  • Urethral injury

  • Rectal injury

  • Bladder injury

  • Vaginal injury





Contusion

  • Contusion

  • Deformity

  • Palpation

  • Pelvic pressure and compression

  • Vascular exam

  • Neurologic exam



PITFALLS

  • PITFALLS

  • SPINE FRACTURES

  • Fractures with vascular compromise

  • Pelvic fractures

  • Digital fractures



Immobilization of entire patient

  • Immobilization of entire patient

  • Reevaluate GCS

  • Cranial nerve exam

  • Motor exam

  • Sensory exam

  • Monitor frequently for changes in neuro status

  • Assess O2 delivery if changes noted

  • Early neurosurgical consultation



PITFALLS

  • PITFALLS

  • Increased intracranial pressure

  • Subdural hematoma

  • Epidural hematoma

  • Depressed skull fracture

  • Spine injury

  • Beware of unconscious patient







Continuous reevaluation

  • Continuous reevaluation

  • Definitive care




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