Professional Documents
Culture Documents
CARE
PROF. R.N.MANGAUL
H.O.D SURGERY
M.K.C.G.MEDICAL
COLLEGE
SIGNIFICANCE
Serious public health problem.
EPIDEMOLOGY
3%
4%
5%
8%
8%
14%
2% 2%
28%
26%
MVA(28%)
FALL
SPORTS
PEDESTRIAN
BIKE
ATV
ASSAULT
STRUCK
BURN
STAB
STATISTICS
INTERNATIONAL ( U.S ) (www.cdc.gov)
Number of unintentional injury deaths :
123,706
Deaths per 100,000 population: 41.0
Cause of death rank: 5
INDIAN ( traumaindia.org )
nearly 80,000 lives were lost and
330,000 people were injured
78% were men in age group of 20-44 years,
causing significant impact on productivity
Trauma care
THE PERFECT
STORM FOR
ERRORS
UNSTABLE PATIENTS
INCOMPLETE HISTORIES
TIME CRITICAL DECISIONS
CONCURRENT TASK
MANY DISCIPLINES
LONG WORKING HOURS
6
Prehospital Care
Triage decision scheme to determine
best level of care required
Initiation of care based on protocols
Attempt to stabilize patient
Rapid transport
9
Color Codes
Triage Tag
RED
: Most
critical injury
YELLOW : Less critical
injured
GREEN
: No life or
limb threatening injury
BLACK/BLUE
:
Death or obviously fatal
injury
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Emergency Departments
From tertiary hospitals to very small community
hospitals
All responsible for initiation of management
ATLS designed primarily as a regimented,
prioritized approach to trauma care (in particular
for survival in small center with little staff)
Inter hospital agreements to care for injuries
beyond resources
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1. Preparation
2. Triage
3. Primary Survey (ABCDEs)
4. Resuscitation
5. Adjuncts to primary survey & resuscitation
6. Secondary Survey (head to toe evaluation &
history)
7. Adjuncts to secondary survey
8. Continued post-resuscitation monitoring & reevaluation
9. Definite care.
13
HEAD TRAUMA
PRIMARY BRAIN
INJURY
CONTUSION
DIFFUSE AXONAL
INJURIES
FALSE ATTRIBUTION
CORTICAL
CT
LACERATIONS
MISINTERPRETATION
SECONDARY BRAIN
INJURY
HYPOXIA
HYPOTENSION
RAISED ICP > 20mm
Hg
LOW CEREBRAL
PERFUSION
PRESSURE
PYREXIA
SEIZURES
METABOLIC
DISTURBANCES
15
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SPINAL TRAUMA
OVER RELIANCE ON
PHYSICAL SIGNS
INADEQUATE
DIAGNOSTIC
IMAGING
HIGH SUSPICION IF:
NEUROLOGICAL
DEFICIT
MULTIPLE INJURIES
FACIAL INJURIES
HIGH ENERGY INJURY
2ND
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AIRWAY
ISSUES
OESOPHAGEAL
INTUBATION
AIRWAY FLAIL
BEST
SURGICAL
AIRWAY
19
NEEDLE
CRICOTHYROIDOTOMY
OPEN
CRICOTHYROIDOTOMY
20
FAILURE TO RECOGNIZE
HEMORRHAGIC SHOCK
COMPENSATED
4
CATEGORIES SHOCK
NORMAL
RESPONDERS
TRANSIENT
RESPONDERS
NON
RESPONDERS
MISINTERPRETAT
ION
EXTREMES OF
AGE
21
B P FLUCTUATION IN
ONGOING BLOOD LOSS
SAW TOOTHED GRAPH
22
RESUSCITATION
ACIDOSIS
COAGULOPATHY
PROLONGED
SHOCK STATE
ARDS
MULTI ORGAN
FAILURE
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SUBCLAVIAN AND
INT. JUGULAR
VIEN LINES
PNEUMOTHORAX
VENOUS INJURY
ARTERIAL INJURY
FALSE PASSAGE
INFECTION
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CARDIAC TAMPONADE
26
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TENSION
PNEUMOTHORAX
Air enters pleural space
and cannot escape
Rx: emergency
decompression before
CXR
Either large bore cannula
in 2nd ICS, MCL or insert
chest tube
CXR to confirm site of
insertion
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COMPLICATIONS OF
CHEST TUBE
MISPLACEMENT
INFECTION
LUNG, LIVER AND
SPLEEN INJURY
INTERCOSTAL
INJURY
OCCLUSION
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ASSESSMENT OF ABDOMEN
M.C ERROR IN TRAUMA
MANAGEMENT
UNSTABLE PATIENT
FAST OR DPL
STABLE PATIENT
CT SCAN
WHOLE BODY CT SCAN FOR
SEVERELY INJURED
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PELVIC FRACTURE
M.C.C OF DEATH MANAGEMENT
IS HEMORRHAGE
MULTIDISCIPLINA
RY
ORGANISATIONA
L
PELVIC BINDER
PELVIC PACKING
EXTERNAL
FIXATION
ANGIOGRAPHY
AND
EMBOLISATION
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CAUSES OF MISSED
INJURIES
TRAUMA SEVERITY
MULTIPLE SYSTEMS
SEVERE BRAIN
INJURY
ALTERED
CONSIOUSNESS
SEDATION
INTOXICATION
EARLY SURGERY
IMPROPER
ATTENTION
REFERRAL
WORKLOAD
EXCESS
INADEQUATE
EXAMINATION
INACCURATE
INTERPRETATION
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PAEDIATRIC TRAUMA
BE READY WITH AGE/SIZE SPECIFIC
EQUIPMENTS
MORE SUSCEPTIBLE TO HYPOTHERMIA
GREATER PHYSIOLOGIC CAPACITY
RAPID DETERIORATION
RESPIRATION TOP PRIORITY
COMMONEST CAUSE OF DEATH HEAD
INJURY
CHILD ABUSE
34
TRAUMA IN ELDERLY
MINIMAL PHYSIOLOGIC RESERVE
THERAPEUTIC WINDOW OF PRELOAD
DENTITION STATUS, NASOPHARYNGEAL
FRAGILITY, C-SPINE AND TMJ ARTHRITIS
120/80 MAY BE ABNORMAL
CORTICAL ATROPHY
MI SECONDARY TO PAIN OR OVER
TRANSFUSION
DECREASE IN CONNECTIVE TISSUE INTEGRITY
BETA-BLOCKERS AND CCB MASK TACHYCARDIA
35
TRAUMA IN PREGNANCY
URINE PREGNANCY TEST IS
A MUST
FAST DONE OVER UTERUS
EARLY DIAGNOSIS OF
PLACENTAL INJURY AND
DIRECT FETAL INJURY
DANGER SIGNS
ABNORMAL FH, VAGINAL
BLEEDING, RUPTURED
MEMBRANE AND
DISTENDED PERINEUM
TREAT THE MOTHER TO
TREAT THE FETUS
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REDUCING ERRORS
INTENTION ERRORS ARE REDUCED
BY PROTOCOLS AND ALGORITHMS
DIAGNOSTIC LABELLING
FALSE NEGATIVE PREDICTION
FALSE ATTRIBUTION
ASSUME NOTHING , TRUST NO ONE
MISSED INJURIES AND DELAYED
DIAGNOSIS
37
GENERAL PRINCIPLES IN
TRAUMA MANAGEMENT
1. MANAGE
ACCORDING TO
THE WORST
REASONBLE CASE
SCENARIO
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2. LISTEN CAREFULLY
BUT A BIT
SKEPTICAL
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3) LOOK CAREFULLY
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4. CONSTANTLY
REASSESS
AND NEVER
ASSUME
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5. TRAUMA CARE IS
A TEAM SPORT
42
6. MAINTAIN CLOCK
SPEED
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7. NEVER BECOME
MARRIED TO
INITIAL DIAGNOSIS
44
THANK YOU
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