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Initial Assessment & Management Polytrauma: July 4, 2015 1
Initial Assessment & Management Polytrauma: July 4, 2015 1
ELIZABETH
LECTURE 1
INITIAL
ASSESSMENT
&
MANAGEMENT
POLYTRAUMA
July 4, 2015
MANAGEMENT OF POLYTRAUMA
CASE SCENARIO
July 4, 2015
MANAGEMENT OF POLYTRAUMA
OBJECTIVES
July 4, 2015
MANAGEMENT OF POLYTRAUMA
STANDARD
PRECAUTIONS
Cap
Gown
Gloves
Mask
Shoe covers
Goggles / face
shield
July 4, 2015
MANAGEMENT OF POLYTRAUMA
CONCEPT OF INITIAL
ASSESSMENT
Primary Survey
Definitive Care
Adjuncts
Resuscitation
Reevaluation
Reevaluation
Detailed
Secondary
Survey
Adjuncts
MANAGEMENT OF POLYTRAUMA
QUICK ASSESSMENT
July 4, 2015
MANAGEMENT OF POLYTRAUMA
QUICK ASSESSMENT
Identify yourself
Ask the patient his or her name
Ask the patient what happened
July 4, 2015
MANAGEMENT OF POLYTRAUMA
QUICK ASSESSMENT
Patent airway
D
July 4, 2015
Clear sensorium
MANAGEMENT OF POLYTRAUMA
PRIMARY SURVEY
July 4, 2015
MANAGEMENT OF POLYTRAUMA
PRIMARY SURVEY :
AIRWAY
MANAGEMENT OF POLYTRAUMA
10
PRIMARY SURVEY
: BREATHING
Respiratory rate
Chest movement
Air entry
Oxygen saturation
July 4, 2015
Pitfalls
MANAGEMENT OF POLYTRAUMA
11
PRIMARY SURVEY
Assess for organ perfusion by :
Level of
consciousness
Skin color and
temperature
Pulse rate and
Management for organ perfusion by :
character
Control
hemorrhage
CIRCULATION
Pitfalls
Elderly
Children
Athletes
Medications
Restore volume
Reassess patient
MANAGEMENT OF POLYTRAUMA
July 4, 2015
12
PRIMARY SURVEY
: DISABILITY
Baseline neurologic
evaluation
Glasgow Coma Scale
score
Pupillary response
Caution
Observe for
neurologic
deterioration
July 4, 2015
MANAGEMENT OF POLYTRAUMA
13
PRIMARY SURVEY
EXPOSURE / ENVIRONMENT
Prevent
hypothermia
Pitfalls
Missed
injuries
July 4, 2015
MANAGEMENT OF POLYTRAUMA
14
RESUSCITATION
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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ADJUNCTS TO PRIMARY
SURVEY
Vital signs
ABGs
ECG
PRIMARY SURVEY
Urinary
output
Urinary / gastric catheters
unless contraindicated
July 4, 2015
MANAGEMENT OF POLYTRAUMA
Pulse
oximeter
and CO2
16
ADJUNCTS TO PRIMARY
SURVEY
DIAGNOSTIC TOOLS
July 4, 2015
MANAGEMENT OF POLYTRAUMA
17
ADJUNCTS TO PRIMARY
SURVEY
DIAGNOSTIC TOOLS
1.Fast
2.DPL
July 4, 2015
MANAGEMENT OF POLYTRAUMA
18
SECONDARY SURVEY
the secondary
survey
History
Physical exam: Head
to toe
Complete neurologic
exam
Special diagnostic
tests
MANAGEMENT OF POLYTRAUMA
Reevaluation
19
SECONDARY SURVEY
History
Allergies
Medications
Past
illnesses
Last
meal
Events
/ Environment /
Mechanism
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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SECONDARY SURVEY
Mechanisms of Injury
July 4, 2015
MANAGEMENT OF POLYTRAUMA
21
SECONDARY SURVEY
Head
External exam
Scalp palpation
Comprehensive
eye and ear
exam
Including
visual acuity
July 4, 2015
Pitfalls
Unconsciousness
Periorbital edema
Occluded auditory
canal
MANAGEMENT OF POLYTRAUMA
22
SECONDARY SURVEY
Maxillofacial
Bony crepitus
Deformity
Malocclusion
Pitfalls
Potential
airway
obstruction
Cribriform plate fracture
Frequently missed
July 4, 2015
MANAGEMENT OF POLYTRAUMA
23
SECONDARY SURVEY
Neck (Soft
Tissues)
Mechanism:
Symptoms:
hoarseness
Findings:
Blunt vs penetrating
Airway obstruction,
Crepitus, hematoma, stridor, bruit
Pitfalls
Occult injuries
MANAGEMENT OF POLYTRAUMA
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SECONDARY SURVEY
Chest
Inspect
Palpate
Percuss
Auscultate
X-rays
July 4, 2015
MANAGEMENT OF POLYTRAUMA
25
SECONDARY SURVEY
Abdomen
Inspect /
Auscultate
Palpate / Percuss
Reevaluate
Special studies
Pitfalls
July 4, 2015
MANAGEMENT OF POLYTRAUMA
26
SECONDARY SURVEY
Perineum
Contusions, hematomas, lacerations,
urethral blood
Rectum
Sphincter tone, high-riding prostate, pelvic
fracture,
rectal wall integrity, blood
Pitfalls
Urethral injury
Vagina
Pregnancy
Blood, lacerations
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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SECONDARY SURVEY
Pelvis
Pain on palpation
Leg length unequal
Instability
X-rays as needed
Pitfalls
Excessive pelvic
manipulation
July 4, 2015
Underestimating pelvic
blood loss
MANAGEMENT OF POLYTRAUMA
28
SECONDARY SURVEY
Extremities
Contusion,
deformity
Pain
Perfusion
Peripheral
neurovascular
status
X-rays as needed
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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SECONDARY SURVEY
Pitfalls
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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SECONDARY SURVEY
Neurologic:
Brain
GCS
Pupil size and
reaction
Lateralizing signs
Frequent
reevaluation
Prevent secondary
brain injury
July 4, 2015
MANAGEMENT OF POLYTRAUMA
Early
neurosurgical
consult
31
SECONDARY SURVEY
Neurologic: Spinal
Assessment
Whole spine
Tenderness and swelling
Complete motor and sensory exams
Reflexes
Imaging studies
Pitfalls
Altered sensorium
MANAGEMENT OF POLYTRAUMA
32
SECONDARY SURVEY
Early
neurosurgical /
orthopedic
consult
July 4, 2015
MANAGEMENT OF POLYTRAUMA
33
SECONDARY SURVEY
Neurologic
Pitfalls
Incomplete immobilization
Neurologic deterioration
July 4, 2015
MANAGEMENT OF POLYTRAUMA
34
ADJUNCTS TO
SECONDARY SURVEY
Patient
deterioration
Delay of
transfer
Deterioration
during transfer
Poor
communication
July 4, 2015
MANAGEMENT OF POLYTRAUMA
35
PAIN MANAGEMENT
Relief of pain /
anxiety as
appropriate
Administer
intravenously
Careful monitoring is
essential
July 4, 2015
MANAGEMENT OF POLYTRAUMA
36
SUMMARY
Primary Survey
Adjuncts
Resuscitation
Definitive Care
Reevaluation
Reevaluation
Detailed
Secondary
Survey
July 4, 2015
MANAGEMENT OF POLYTRAUMA
Adjuncts
37
ANY
QUESTIONS ?
July 4, 2015
MANAGEMENT OF POLYTRAUMA
38
LECTURE 1
TRAUMA TEAM
CONCEPT &
PHILOSOPHY
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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INTRODUCTION
TRAUMA TEAM
Many studies in developing countries
have shown that > 30% of total hospital
death is due to trauma.
A well integrated trauma system based
upon TEAMWORK and PARTNERING
can reduce the mortality rate to less than
10%.
July 4, 2015
MANAGEMENT OF POLYTRAUMA
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TEAM WORK
ORGANISATION OF TEAMWORK
MANAGEMENT OF POLYTRAUMA
41
VERTICAL TEAM
ORGANISATION
MANAGEMENT OF POLYTRAUMA
42
VERTICAL TEAM
TEAM
LEADER
WORKER 1
WORKER 3
WORKER 2
July 4, 2015
MANAGEMENT OF POLYTRAUMA
43
HORIZONTAL TEAM
ORGANISATION
MANAGEMENT OF POLYTRAUMA
44
HORIZONTAL TEAM
TEAM LEADER
WORKER 1
July 4, 2015
WORKER 2
MANAGEMENT OF POLYTRAUMA
WORKER 3
45
TEAM WORK
MANAGEMENT OF POLYTRAUMA
46
TRAUMA TEAM
MANAGEMENT OF POLYTRAUMA
47
TRAUMA TEAM
MANAGEMENT OF POLYTRAUMA
48
July 4, 2015
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49
RESUSCITATION ZONE
MANAGEMENT OF POLYTRAUMA
50
Team Leader :
The most experienced personnel
Perform the most important aspects of
the management e.g primary survey
and resuscitation procedures.
July 4, 2015
MANAGEMENT OF POLYTRAUMA
51
TRAUMA TEAM
Phase II
From 3 - 6 hours :
6 Member Team
additional members
from the respective departments.
July 4, 2015
MANAGEMENT OF POLYTRAUMA
52
SUMMARY
PIT STOP
in a
MANAGEMENT OF POLYTRAUMA
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INITIAL ASSESSMENT
ANY
QUESTIONS ?
July 4, 2015
MANAGEMENT OF POLYTRAUMA
54