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MANAGEMENT
SYAFRI K.ARIF
Dept.of Anesthesiology,Pain Management and Intensive Care
Faculty of Medicine Hasanuddin University
Makassar-Indonesia
INTRODUCTION
The main role of the doctor is
SAVING LIFE
ALLEVIATE SUFFERING
Any doctors should have these
competences.
The main tool of saving life is
BASIC LIFE SUPPORT
ACCIDENTS OR DISASTERS
Accidents or disasters may occur to
:
ANY WHERE
ANY TIME
ANY ONE
Well preparedness is very important
( soft-ware and hard-ware )
Epidemiology of Trauma
Death
Trimodal patterns
ATLS
Donald Trunkey
50%
30%
Death
%
sec
hr
20%
days/week
Trauma Death
First Peak
Death that occurs at
impact or soon after the
accident
50 % death
Not preventable
severe head
laceration, massive
bleeding, heart
injury etc.
Prevention of accidents
enforcement,
education &
awareness
Trauma Death
Second Peak
Death within
minutes to hours
after injury
Golden Hours
30 % of death
Life threatening
injuries involving
airway, breathing ,
circulation
Trauma Death
Airway
obstruction: tongue, secretion & blood,
vomitus
difficult airway management
Breathing & Ventilation
pneumothorax,heamothorax, penetrating
chest injuries, flail chest
Circulation
hemorrhage, cardiac tamponade
Second Peak
Preventable
Reflect
Third peak
Third Peak
INITIAL ASSESMENT
Initial assessment include :
1.
Preparation
2.
Triage
3.
Primary Survey ( ABCDE )
4.
Resuscitation
5.
Secondary Survey ( Head to toe
evaluation )
6.
Definitive Care
1. PREPARATION
Preparation of the trauma patient
occurs
in two different clinical settings
1. PRE-HOSPITAL PHASE
2. IN HOSPITAL PHASE
PRE HOSPITAL
Transportation is very
important
Prehospital Trauma
Resuscitation
Ambulance Response
Time: Standard
50 % of all calls are
responded within 8
min.
95 % of calls within 14
min. (urban)
95 % of calls within 19
min. (rural )
Pre hospital
Communication
Communication
Vital between prehospital & inhospital trauma patient
resuscitation
Prepare ED personnel well
ahead
Activation of TRAUMA TEAM /
DISASTER PLAN into action
2. Triage
Resuscitation Room
Activation of trauma
team
Trauma Team-work
Efficient method
Trained doctors &
nurses
Variety of tasks taken
simultaneously
horizontal organization
reduced time to lifesaving procedure by 50
%
Pit stop in a
formula 1 motor
race
Managing trauma
in a smooth and
efficient manner
Do no further
harm
Difficult Airway
Goal
Keep airway
patent
protect
compromised
airway
provide airway if
none
Suspect:
Unconscious
patients
Injury above
clavicles
Neck pain
Weakness or
neurological deficit
History of fall > 6 m
TENSION PNEUMOTHORAX
Flail Chest
Segmental ribs fracture
of multiple ribs
Panel moves in with
inspiration and out with
expiration
Cardiac
Tamponade
Treatment of Cardiac
Tamponade
Hematothorax
Chest tube
Massive : > 1500 ml blood
Drainage: . 200 ml/hr
CLAMPED CT
Urgent thoracotomy
Circulation
Haemorrhage Control with Fluid therapy
First Priority : Restore volume with fluid
(RL/NaCl 0.9% )
Second Priority :
Restore blood with WB and PRC transfusion
to restore oxygen carrying capacity
Disability
( Neurologic Evaluation )
4. Resuscitation
Circulation
End- Points of
Resuscitation
Traditional:
5. Secondary Survey
Head
Maxillofacial
Cervical spine and Neck
Chest
Abdomen
Perineum / rectum / vagina
Musculoskeletal
Neurologic
6. Definitive Care
Surgical intervention
Transfer to higher trauma center
Conclusion