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Initial Assesment and Management
Initial Assesment and Management
ASSESMENT
MANAGEMENT
Faisal Sommeng
INTRODUCTION
Trimodal patterns
Donald Trunkey
ATLS
50%
Death 30%
20%
%
sec hr 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
Circulation
hemorrhage, cardiac tamponade
Second Peak
Preventable
Reflect
adequacy, efficiency of EMS in
prehospital resuscitation
hospital emergency department
resuscitation
definitive therapy
Third peak
Third Peak
Death within days or
week after injury
20 % death
Sepsis or multiorgan
failure
Reflects again
efficiency at
resuscitation,
definitive care,
aggressive ICU care,
prevention of infection
and rehabilitation
INITIAL ASSESMENT
1. PRE-HOSPITAL PHASE
2. IN HOSPITAL PHASE
PRE HOSPITAL
Transportation is very
important
Continous Training
Medical First Responder.
Indonesian MFR
EMS in F1
EMS
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 )
Nolan JP, Pars. BJA
1997;79,226-240
Pre hospital Communication
Communication
Vital between prehospital & in-
hospital trauma patient
resuscitation
Prepare ED personnel well ahead
Activation of TRAUMA TEAM /
DISASTER PLAN into action
2. Triage
Efficient method
Trained doctors &
nurses
Variety of tasks taken
simultaneously
horizontal organization
reduced time to life-
saving procedure by 50 %
Trauma Team at Work
Difficult Airway
Goal
Keep airway patent
protect compromised
airway
provide airway if none
Difficult Airway Management .
Cervical spine Fracture
Suspect:
Unconscious patients
Injury above clavicles
Neck pain
Weakness or
neurological deficit
History of fall > 6 m
Breathing & Ventilation
Patient in increasing respiratory distress,
BLUE, BLUE, BLUE, BP DOWN, Not
Recordable...
Think :Tension Pneumothorax,
haemotothorax, Flail chest, lung
contusion, cardiac tamponade
Chest tube
Massive : > 1500 ml blood
Drainage: . 200 ml/hr
CLAMPED CT
Urgent thoracotomy
Circulation
Haemorrhage Control with Fluid therapy
Traditional:
Achieved definitive care
Blood Pressure/ cerebral perfusion
pressure/ ICP
Heart rate
Urine output
5. Secondary Survey
Not begin until the Primary Survey is
completed
Is Head to Toe evaluation
Head
Maxillofacial
Cervical spine and Neck
Chest
Abdomen
Perineum / rectum / vagina
Musculoskeletal
Neurologic
6. Definitive Care
Surgical intervention
Transfer to higher trauma
center
Conclusion
Trauma continues to be the most
common cause of death
BLS playing a big role in saving life in pre-
hospital phase or in hospital
Do No Further Harm is the basic
principle of BLS
ABCDE is a good guide to take action.