Post on 23-Oct-2015
transcript
Assesment of Multiple Trauma Patient
Plenary LectureBy
Freda S.Halim, SpBPelita Harapan University
2012
Initial Assesment of Multiple Trauma Patient
Preparation ( prehospital phase, hospital phase )
Triage
Primary Survey + resuscitation• Adjuncts to primary survey and resuscitation : ECG, gastric catheter• Consider need for patient transfer
Secondary survey• Adjuncts to secondary survey
Continued postresuscitation monitoring and reevaluation
Definitive care
Preparation : Prehospital PhaseEvery effort should be made to minimize scene time!
Emphasis should be placed on : airway maintenance, control of external bleeding and shock, immobilization of the patient, immediate transport to the closest appropriate facility/trauma center
Also important : obtaining and reporting information needed for triage at the hospital
Preparation : hospital phase
Triage area
Resuscitation area
Ready to use equipments
Ready healthcare personnels ( doctors,nurses)
Ready to call additional medical assistance
TriageSorting of patients based on their need for treatment, and the decision regarding to which medical facility they should be transported
Useful in multiple casualties and mass casualties
Primary Survey+ResuscitationAirway maintenance with cervical spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability : neurologic status
Exposure
Quick, simple way to asses the patient in 10
seconds!
Life threatening conditions
are identified,
and management is instituted simultaneou
sly!!
Prioritized assessment
and management
are in sequential steps in order of
importance!!
Purpose :
Airway +C-Spine ontrol
• Recognition of patient with potency of airway compromiseairway control
• C-spine control
We do :• Cleansing the airwaysuction• Jaw thrust, chin-lift• Oropharyngeal airway• Definitive airway ( endotracheal intubation,
tracheostomy• C-spine control should be indicated in every
multiple trauma patient
Breathing and ventilation
• Quick assesment !! :– Inspection :
• Freq of the resp rate• Chest shape and movement
– Percussion : sonor/hipersonor/dull
– Palpation: crepitation, tenderness
– Auscultation: normal/decreased VBS
We do :Oxygenation, portable chest x-ray, chest tube insertionMonitoring the oxygen saturation,ventilatory support
• Rib fractures• Pneumothorax•Hematothorax
•Hematopneumothorax• Flail chest
• Lung contusion• Tension pneumothorax• Cardiac tamponade
Tension pneumothorax!
Circulation and Hemorrhage control
• Quick assesment !! :– HR– Blood pressure– Skin perfusion– Urine output
We do : put 2 large bores IV needles,2000cc warmed crystalloid infusion,blood crossmatch,urine catheter insertion, hemorrhage control
•Hypovolemic shock• Cardiac shock
•Distributive shock• Spinal shock• Septic shock
Hypovolemic shock : grade 1,2,3,4
Disability : neurological examination
• Quick assesment !! – GCS– Pupils– Neurological exam :
motoric and sensoric function
We do : oxygenation, consider intubation in severe head injury, head up, immobilization of the spine
No head injuryMild head injury
Moderate head injurySevere head injury
So when we do the history taking?what is important in history taking of multiple trauma
patient?
At the same time when the patient is on primary survey and resuscitation
• Chief complain• Onset of trauma!• Mechanism of trauma!• Injury sustained
should be quick, practical and organized
Secondary SurveyIt is the time for Head-to-toe examination of the trauma patient, combined with complete history and physicial examination.It is the time for recognizing the less dangerous injury,
It is the time to do more sophisticated investigation
It is the time to give further treatment for the injury
Shouldn’t start if the primary survey is not finished or clear!!!
Primary survey
Secondary survey
Continued Postresuscitation Monitoring and Reevaluation
• Depends on the trauma type• Depends on the facility and equipments
provided by the hospital• Depends on the ability of the healthcare
personnel
Definitive Care
• Which patients do i transfer to a higher level of care?when should the transfer occur?
Take Home Message• Multiple traumashould be managed by trauma team• Priority of the trauma patient is different than non-
trauma patient : all should be quick and organized– History taking, physical examination and immediate
treatment come into one package : primary survey!!!– Head to toe exam, complete history taking, other
sophisticated investigations, further treatments come in secondary survey
• Equipped yourself!
Source
• Advanced Trauma Life Support, 2008• Feliciano and Moore, Trauma, 2006,6th ed
THANK YOU