Evaluation of trauma patient

Basic primary and secondary assessment for trauma patient

1. Evaluation of Trauma Patient UG Batch 2017 Date- 3/9/21 Dr. Ankita Singh Assistant Professor Department of Surgery

2. Learning Objectives How to identify and assess the severely injured patient Early treatment goals for multiply injured patients

3. What is Trauma? Trauma originates from the Greek word meaning ‘wound ’ I mplies that a physical force exerted on a person has led to a physical injury Physical forces: Mechanical, Thermal, Chemical, Ionizing radiation Major trauma: injuries to more than one body region/ organ systems

4. Role of Trauma Team To apply the principles of Advanced Trauma Life Support (ATLS) to rapidly identify, and treat life-threatening injuries during the primary survey. Activity can occur concurrently instead of sequentially Team leader : constantly anticipates next move

5. Evaluation & Management Primary Survey c – Control of massive external haemorrhage A – Airway with cervical spine protection B – Breathing and ventilation C – Circulation and haemorrhage control D – Disability (neurological status) E – Exposure (assess for other injuries) Aim to identify and manage the most immediately life-threatening pathologies first

6. Evaluation & Management.. Secondary Survey: detailed top to toe examination after life-threatening injuries have been identified and managed during the primary survey Tertiary Survey: Required for patient – inresponsive during primary & secondary survey Done once patient is conscious & alert To identify any missed minor injuries

7. PRIMARY SURVEY

8. c control of exsanguinating external haemorrhage Immediate control by : packs & direct pressure Tourniquets- record time of application Hemostatic dressings

9. A A irway & cervical spine stabilization Cervical spine immobilization & protection Return head to neutral position MILS- Maintain in-line stabilization Correct size collar application Blocks/tape Sandbags

10. A.. A irway & cervical spine stabilization Assessment of patency of airway If compromised: stepwise Suction Airway maneovers - jaw thrust, chin lift Insertion of airways- oropharyngeal / nasopharyngeal Airway support- O2, NRBM, Bag & mask Advanced airway maneover - endotracheal intiubation DIFFICULT AIRWAY!!- Cricothyroidotomy /tracheostomy

11. B Breathing & ventilation Oxygen: 100% high flow (15 L/min) LOOK, FEEL, LISTEN: Assess bilateral chest rise, visible injury, tenderness, bony crepitus, breath sounds Pulse oximetry Treat identifiable injury Pneumo / hemothorax , flail chest

12. C Circulation & Haemorrhage Assessment for hemodyanamic status At least 2 wide bore IV cannulae Equipments Central/ intraosseous venous access Blood withdrawn- group, crossmatch , Hb , lactate Pelvic Binder application : unstable Hypotensive trauma patients are treated as hypovolaemic until proven otherwise

13. C.. Circulation & Haemorrhage Hypotensive trauma patients are treated as hypovolaemic until proven otherwise Simultaneous fluid resuscitation & identification of the source of the haemorrhage Aim of resuscitation: maintain blood supply to vital organs Target SBP: 70-90mmHg Fluid challenge

14. C.. Circulation & Haemorrhage Excessive crystalloids avoided Identify primary source of haemorrhage and control it ASAP Resuscitated with blood and blood products MTP: Massive Transfusion Protocol Role of Tranexamic acid

15. C.. Circulation & Haemorrhage Identify primary source of haemorrhage and control it ASAP Sites: chest, abdomen, pelvis, long bones and external haemorrhage Multiple sources Investigations: X Rays- Chest, pelvis, & suspicious site USG- FAST Focused Abdominal Sonography for Trauma CECT Torso NCCT head

16. D Disability Glasgow Coma Scale- GCS E: eye, V: verbal, M: motor Pupils: size & reaction Neurological examination

17. E Exposure Exposed head to toe Record temperature Keep warm Spine examination- LOG ROLL

18. SECONDARY SURVEY

19. Detailed head to toe examination Assess injuries, bones, joints, abdomen other systems Identification marks Examine orifices History: Patient details Mechanism of injury Comorbidities

20. What did we learn? cABCDE of Trauma care- Primary survey It is not just evaluation, rather simultaneous management also Outcome of patient depends upon- competency of surgical team

21. Questions please Attendance!!