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Introduksi Trauma DR - Zulkarnaini, SP - OT
Introduksi Trauma DR - Zulkarnaini, SP - OT
Introduksi Trauma DR - Zulkarnaini, SP - OT
TRAUMA OVERVIEW
Epidemiology
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Principle
Save patient as much as possible
Prior to patient who will survive (field)
Prior to severe trauma patient
Do not further harm
Work as a team
Communication
Save the patient is important but to save
your self is more important
Multi Trauma
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Physiologic criteria
Anatomic criteria
Mechanism of injury
continued
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Anatomic Criteria
Injury to specific a body part/area
requiring immediate surgical
intervention
Injuries to the head and chest
Multiple musculoskeletal injuries
Amputations
Severely mangled extremities
Pelvic injuries
Mechanism of Injury
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Why ATLS?
Trimodal death distribution
First peak instantly (brain, heart, large vessel injury)
Second peak minutes to hours
Third peak days to weeks (sepsis, MSOF)
ATLS focuses on the second peak..Deaths from:
Head injuty, Epidurals, Subdurals,
Basilar skull fractures, orbital fractures, NEO complex injury
Penetrating neck injuries
Spinal cord syndromes
Cardiac tamponade, tension pneumothorax, massive hemothorax, esophageal
injury, diaphragmatic herniation, flail chest, sucking chest wounds, pulmonary
contusion, tracheobronchial injuries, penetrating heart injury, aortic arch injuries
Concepts of ATLS
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Trauma captain
Interventionalists
Nurses
Recorder
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Trauma Team
Primary Survey
Patients are assessed and treatment
priorities established based on their
injuries, vital signs, and injury mechanisms
ABCDEs of trauma care
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A
B
C
D
E
Airway
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A- Airway
Airway should be assessed for patency
Is the patient able to communicate verbally?
Inspect for any foreign bodies
Examine for stridor, hoarseness, gurgling, pooled
secrecretions or blood
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Airway Interventions
Supplemental oxygen
Suction
Chin lift/jaw thrust
Oral/nasal airways
Definitive airways
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Difficult Airway
Breathing
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B- Breathing
Airway patency alone does not ensure
adequate ventilation
Inspect, palpate, and auscultate
Deviated trachea, crepitus, flail chest, sucking chest
wound, absence of breath sounds
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Flail Chest
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Subcutaneous Emphysema
Breathing Interventions
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C- Circulation
Hemorrhagic shock should be assumed in
any hypotensive trauma patient
Rapid assessment of hemodynamic status
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Level of consciousness
Skin color
Pulses in four extremities
Blood pressure and pulse pressure
Circulation Interventions
Cardiac monitor
Apply pressure to sites of external hemorrhage
Establish IV access
2 large bore IVs
Central lines if indicated
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D- Disability
Abbreviated neurological exam
Level of consciousness
Pupil size and reactivity
Motor function
GCS
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GCS
EYE
VERBAL
MOTOR
Spontaneous 4 Oriented
Obeys
Verbal
Confused
4 Localizes
Pain
Words
Flexion
None
Sounds
Decorticate
None
Decerebrate 2
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None
Disability Interventions
Spinal cord injury
High dose steroids if within 8 hours
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E- Exposure
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Lets do a Case!
Stabilize this patient
Secondary Survey
AMPLE history
Allergies, medications, PMH, last meal, events
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Trauma Scoring
Numerical rating system for trauma
Assigns number to certain patient
characteristics to create a score
Objectively describes severity
Helps determine transport to a trauma
center or local hospital
Helps trauma centers evaluate the care
of similar patients
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HEENT
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Seatbelt Sign
Diagnostic Aids
Standard trauma labs
Routine Blood Examination, BGA, Electrolyte, ect
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CT/FAST scans
Must be monitored in radiology
Should only go to radiology if stable
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Simple Pneumothorax
Tension Pneumothorax
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Hemato thorax
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Widened Mediastinum
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PELVIC FRACTURE
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Epidural Hematoma
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Abdominal Trauma
Common source of traumatic injury
Mechanism is important
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Abdominal Trauma
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Splenic Injury
Most commonly injured organ in blunt trauma
Often associated with other injuries
Left lower rib pain may be indicative
Often can be managed non-operatively
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Liver injury
Second most common solid organ injury
Can be difficult to manage surgically
Often associated with other abdominal
injuries
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Liver contusions
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Trace the
Diaphragm
Outline. Where is
the
Diaphragm on the
left?
Abdominal contents
Up in the chest on the
left
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bowel
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mesentery
CT Scan in Trauma
Abdominal CT scan visualizes solid organs
and vessels well
CT does NOT see hollow viscus, duodenum,
diaphram, or omentum well
Some recent surgery literature advocates
whole body scans on all trauma
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FAST Exam
Focused Abdominal Scanning in Trauma
4 views: Cardiac, RUQ, LUQ, suprapubic
Goal: evaluate for free fluid
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See normal
Liver and kidney
Free fluid in Morrison's
Pouch between liver and
kidney
Non-accidental Trauma
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Key is SUSPICION!!!
Incongruent stories of mechanism
Delay in seeking treatment
Multiple stages of injuries
Pattern Injuries
Multiple hospital visits
Injury mechanism beyond the scope of the age of
child (6week old rolled over off the bed)
Bite marks, submersion injury, cigarette burns
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Serial examinations
CHI with regain of consciousness
Abdominal exams for documented blunt trauma
Pulmonary contusions with blunt chest trauma
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Summary
Trauma is best managed by a team
approach (theres no I in trauma)
A thorough primary and secondary survey
is key to identify life threatening injuries
Once a life threatening injury is discovered,
intervention should not be delayed
Disposition is determined by the patients
condition as well as available resources.