MULTIPLE INJURIES

MULTIPLE INJURIES
Terminology:

Injury = the result of harmful event that

arieses from the release of specific forms of energy.

Multiple injuries = Polytrauma = injury of

two or more systems, one or the ombination imperil vital signs.

Trauma deaths
FIRST PEAK Within minutes of injury Due to major neurological or vascular injury Medical treatment can rarely improve outcome SECOND PEAK Occurs during the 'golden hour' Due to intracranial haematoma, major thoracic or abdominal injury Provide advanced trauma life support THIRD PEAK Occurs after days or weeks Due to sepsis and multiple organ failure

Assessment of the INJURED PATIENT

Primary survey and resuscitation

A = Airway and cervical spine
B = Breathing C = Circulation and haemorrhage control D = Dysfunction of the central nervous system E = Exposure

Secondary survey Definitive treatment

AIRWAY
Asses for obstruction , tracheal injuries, deviated tracheal

etc

Apply cervical collar to immobilize neck and prevent further

injury

Open airway by doing jaw thrust maneuver

Open mouth, remove the obstruction or secretion Do suction to remove any obstruction eg;secretion,blood or

any foreign body

Insert orophryngeal or nasopharyngeal airway to maintain

patency of airway.

Breathing

Check for spontaneous breathing for 10 sec by look listen and feel. Check for:
- rate - depth - use of accessory muscle at neck and abdomen to breath - sign of resp.distress: wheezing, crowing, gurgling

Circulation and haemorrhage control

Assess pulse, capillary return and state of

neck veins
Identify exsanguinating haemorrhage and

apply direct pressure

Give intravenous fluids (crystalloid or

colloid)
Attach patient to ECG monitor

Dysfunction / disability
Assess level of consciousness using AVPU

method A = alert V = responding to voice P = responding to pain U = unresponsive

Assess level of consciousness by performing

GCS
Assess pupil size, equality and responsiveness

EXPOSURE
from HEAD to TOE Check any other injury by doing head to toe

examination to detect any injury like deformity, laceration, abnormal movement of the body

If limb injury present immobilize:

Use RICE technique

R I C E-

Rest the patient Ice Compression Elevation.