Trauma mangement
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The document discusses trauma management and activation of a trauma team. It outlines the Advanced Trauma Life Support (ATLS) protocol which involves a primary survey to identify life-threatening injuries, followed by a secondary survey and development of a treatment plan. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environment. It provides details on assessing each component and treating critical issues like tension pneumothorax, massive bleeding, and neurological impairment.
Trauma mangement
- 2. Activation of a Trauma Team Doctors from different specialties, nurses and radiographers. Team leader: Takes all Triage decisions and coordinates the entire resuscitative effort. Hospital is informed about the impending arrival of a casualty.
- 3. Prehospital Retrieval and Management Approach: Scoop & Run policy Stay & Play policy Universal precautions
- 4. Advanced Trauma Life Support (ATLS) Primary survey and Resuscitation: Identify and treat what is killing the patient. Secondary survey: Proceed to identify other injuries. Definitive care: Develop a definitive management plan.
- 5. ATLS- Primary Survey A – Airway maintenance & Cervical Spine protection. B – Breathing & ventilation. C – Circulation & hemorrhage control D – Disability limitation E – Exposure & environment.
- 6. ATLS- PRIMARY SURVEY A-AIRWAY If pt. can speak- not immediately threatened. If not, rapid assessment needed. Inspection: foreign bodies, maxillofacial or tracheal /laryngeal fractures Cervical spine injury in multisystem injury, injury above the clavicle.
- 7. ATLS- Primary Survey B- Breathing & ventilation • High flow oxygen using reservoir mask • Inspection • Palpation • Movement • Auscultation The aim is to identify & treat the life threatening thoracic conditions.
- 8. ATLS- Primary Survey B- Breathing & ventilation Five life threatening thoracic conditions: 1. Tension Pneumothorax 2. Massive Hemoperitoneum 3. Open chest injuries 4. Cardiac tamponade
- 9. ATLS- Primary Survey C- Circulation and bleeding control Tachycardia in a cold patient indicates shock Causes of shock following injury: 1. Hypovolemic 2. Cardiogenic 3. Neurogenic 4. Septic
- 10. ATLS- Primary Survey C- Circulation and bleeding control Assessment of blood loss -External or obvious -Internal or covert: chest abdomen retroperitoneum muscle compartments Resuscitation Arrest bleeding Obtain vascular access
- 11. ATLS- Primary Survey C- Circulation and bleeding control External bleeding must be controlled. IV access Blood for cross-match. Bolus of warm crystalloid. Timely surgical intervention to arrest haemorrhage.
- 12. ATLS- Primary Survey D- Disability limitation C.N.S. • Rapid assessment of motor & sensory functions • Glassgow coma scale • Pupillary assessment by prehospital personnel ATLS-Primary survey E- Exposure and environment • Remove remaining clothing. • Prevent hypothermia.
- 13. Adjunct to primary survey • Monitoring- ECG, non-invasive BP, pulse oximetry • Urinary and gastric catheters • Diagnostic studies: lateral cervical spine AP chest AP pelvis • Focus Abdominal Sonar for Trauma (FAST) scan • CT scan or diagnostic peritoneal lavage