Professional Documents
Culture Documents
Purnendu Saxena
MS(Orth), DNB (Orth), DOrth (UK), MCh Orth (UK), FRCS (Trauma and Orth)(UK)
Why
Trauma care is need of our society Mortality is high Most of the victims are young and the resultant loss to the families are catastrophic Many of these deaths are preventable
Early care
Requires a wider understanding and not a specialists approach Requires that life threatening priorities are dealt urgently A complete clinical assessment should not be neglected while priorities are being managed Surgical procedures are tailored as per patients general condition
Society for care in emergency
Primary Survey
Identify life threatening conditions following ABCD Manage life threatening conditions Start resuscitation
Secondary survey
Assess everything Head to toe
PRIMARY SURVEY
Priority is ABCDE A- Airway and neck B- Breathing C- Circulation D- Disability E- Environment control This is not a formula to remember for exam!
Why ABCD
Your brain can work only if it can get oxygenated blood through circulation The circulating blood is useful only if it can get oxygenated within breathing lungs A functional lung can be useful only if it get air through a patent airway
Why ABCD
fix the Airway first fix the Breathing lungs next fix the Circulation and then fix the Disability (brain & bones)
What is Airway
What to see
What to do
Monitoring
Breathing
Conduction of air is the function of Airway Breathing is a process in which gaseous exchange takes place Breathing is the function of lungs and ribcage
Trauma Clinicians Often Miss Fractures Tension pneumothorax Cardiac temponade Open wound Massive pneumothorax Flail chest
Society for care in emergency
What to do
Tension pneumothorax
Urgent decompression
Cardiac temponade
Urgent decompression
Open wound
Seal as a valve
Massive pneumothorax
Drain it and put a chest tube
Flail chest
Ventilatory support
Monitoring
Circulation
Circulatory failure leads to reduced tissue perfusion that is Shock Hemorrhagic shock -most likely Nonhemorrhagic
Neurogenic shock Septic shock Mechanical shock pump failure
What to see
Pulse Skin colour and temperature Blood pressure Urine output Consciousness
What to do
Stop obvious bleeding Restore volume rapidly (Fluid challenge) See the response
Disability
What to see
What to do
Environment
At the end of primary survey Get lateral view of C/S Chest Xray Pelvic Xray Cathaterise / intubate / ryles tube if required Start life saving maneuvers like intubation, decompressing tension pneumothorax, and giving IV fluid Consider need for transfer
Society for care in emergency
Secondary survey
Life threatening priorities are identified and their management is started in primary survey Secondary survey focuses on
History Head to toe exam & more complete investigations Deciding priorities
History (AMPLE)
Allergies Medications currently taken Past illness Last meal Event leading to injury
Complete investigations
At the end you should have All Xrays CT / US/ laboratory investigation Tubes and fingers in all orifices
Fixing priorities
There is a controversy Is patient fit enough to undergo another trauma in the form of surgery ? (Dont touch!) Will patient improve / survive without having done a surgery ? (Do it now!)
Damage control surgeries are the middle path ( Do the minimum!) Continued care in ICU
Definitive treatment
Summary
Primary survey
Life threatening priorities managed (ABCD)
Secondary survey
Head to toe exam and all the injuries identified
Definitive management
Thanks