initialassessmentoftraumapatient-200930182558.pdf

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1. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR

2. OBJECTIVES
Initial Assessment of Trauma Patient What, Why and How ABCDE

3. INITIAL
ASSESSMENT
Step One
Preparation
Primary Survey
(Resuscitation and
Adjuncts)
Re-evaluation
Step two
Detailed Secondary Survey
Re-evaluation
Adjuncts
Step Three
Re-evaluation
Definitive care / Transfer
Tertiary Survey

4. PREPARATIO
N
Trauma call
PPE
Assign roles / team
Mobilize resources
Check equipment / Medications
Proper Handover

5. CASE
PRESENTATIO
N
•Mechanism of injuryM
•Injuries suspected I
•SymptomsS
•TreatmentT

6. WHAT IS
THE
SEQUENCE
OF
PRIORITIES
?
•AirwayA
•BreathingB
•CirculationC
•DisabilityD
•Exposure / Environment E

7. WHY ABCDE?

8. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

9. INITIAL
ASSESSMENT
Step One
Preparation
Primary Survey
(Resuscitation and
Adjuncts)
Re-evaluation
Step two
Detailed Secondary Survey
Re-evaluation
Adjuncts
Step Three
Re-evaluation
Definitive care / Transfer
Tertiary Survey

10. SUMMARY
Initial Assessment of Trauma Patient What, Why and How ABCDE

11. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR

12. OBJECTIVES
Assessment of Airway
Management of Airway
What is definitive airway
When to use definitive airway

13. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

14. ASSESSMENT
OF AIRWAY
Speak to the patientSpeak
Look for evidence if facial trauma or burnLook
Listen for noisy airway or no airway soundsListen

15. INITIAL MANAGEMENT OF AIRWAY
O2 VIA TIGHT-FITTING OXYGEN MASK
PULSE OXIMETER
ECG
BLOOD PRESSURE CUFF

16. MANAGEMEN
T OF
COMPROMISE
D AIRWAY
Jaw thrust / No Neck tilt
Suction
Bag-Mask ventilation
Nasopharyngeal / oropharyngeal airway
Extraglottic or Supraglottic airway / LMA
Definitive Airway

17. INDICATIONS
OF
DEFINITIVE
AIRWAY
•Inability to maintain airway
•Impending or potential airway compromise
•Threatened airway / Vomiting / Blood / Facial injury
A
•In ability to maintain oxygenation by facemask
•Apnoea
•Flail segment / Lung contusions
B
•Sever terminal shock
•Combative patients from hypoperfusionC
•Obtundation / Head injury / GCS 8 or less
•SeizuresD
•Anticipate deterioration of any of the above
•Consider Combination of any of the aboveE

18. DIFFICULT
AIRWAY
Surgical Airway
Cannot intubate
Cannot ventilate

19. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

20. SUMMARY
Assessment of Airway
Management of Airway
What is definitive airway
When to use definitive airway

21. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR

22. OBJECTIVES
Assessment of breathing
Immediate life-threatening injuries
Management of immediate life-threatening injuries
Potential life-threatening injuries

23. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

24. IMPORTANCE OF “B”
Airway and breathing problems are interlinked
Causes of shock in the chest
Tension pneumothorax
Massive haemothorax
Cardiac tamponade
These injuries can compound the effects of shock due
to other haemorrhagic and non-haemorrhagic injuries.

25. ASSESSMENT
Ensure adequacy of the airwayEnsure
Look for evidence of respiratory distress
•Tachypnoea
•Use of accessory muscles of respiration
•Look for abnormal/asymmetrical chest wall movement
•Distension of neck veins
•Cyanosis (late finding)
Look
Feel chest and neck
•Hyper-resonance on percussion
•Dullness to percussion
•Subcutaneous air or pain and fractures
•Position of trachea
Feel
Listen for signs of partial airway obstruction or compromise
•Asymmetrical, reduced or absent breath sounds
•Additional sounds (stridor)
Listen

26. ASSESSMENT
/ ADNUNCTS
Perform ECG
Pulse oximetry
End tidal capnography
CXR/CT
FAST
Arterial blood gases

27. IMMEDIATE LIFE-
THREATENING
INJURIES
HUNT FOR
IMMEDIATE LIFE-
THREATENING
INJURIES BEFORE THEY
HUNT YOU

28. IMMEDIATE
LIFE-
THREATENIN
G INJURIES
•Airway obstruction (laryngotracheal injury)
•Tracheobronchial tree injuryAirway
•Tension pneumothorax
•Open pneumothoraxBreathing
•Massive haemothorax
•Cardiac tamponade
•Traumatic Circulatory Arrest
Circulatio

29. POTENTIAL
LIFE-
THREATENIN
G INJURIES
• Simple pneumothorax
• Haemothorax
• Flail chest
• Pulmonary contusion
• Blunt cardiac injury
• Traumatic aortic disruption
• Traumatic diaphragmatic injury
• Blunt oesophageal rupture

30. FINGER THORACOSTOMY TRAUMA-ROOM THORACOTOMY

31. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

32. SUMMERY
Assessment of breathing
Immediate life-threatening injuries
Management of immediate life-threatening injuries
Potential life-threatening injuries

33. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR
Circulation

34. OBJECTIVES
What is shock?
Diagnosis of shock
Management of shock

35. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

36. HOW TO DO ABCDE?
Definitive
airway
A
Immediate
life-
threatening
injuries
B ShockC
Traumatic
brain injury
D ExtraE

37. WHAT IS SHOCK?
Cardiogenic
Distributive
Hypovolemic
Obstructive

38. HOW TO DIAGNOSE SHOCK?
Neuroendocrinal
response
Tachycardia
Pallor
Sweaty
Cold
Thirsty
Hypoxia /
Hypoperfusion
Tachypnoea
Anxiety then Disturbed conscious level
Urine output
Prolonged capillary refill
Low volume
Narrow pulse pressure
Low blood pressure

39. PITFALLS IN DIAGNOSIS
Blood
Pressure
01
Conscious
level
02
Hemoglobin
level
03
Type of
shock
04
Shock due to
brain injury
05

40. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

41. BLOOD IN
THE FLOOR
AND 4
MORE
Chest
Abdomen
Pelvis
Long bone

42. MANAGEMENT OF HAEMORRHAGIC
SHOCK
STOP REPLACE

43. PITFALLS IN C
Blood Pressure
01
Conscious level
02
Hemoglobin level
03
Type of shock
04
Shock due to
brain injury
05
Replacing
without stopping
06

44. BLOOD IN THE
FLOOR AND 4
MORE
Chest
Abdomen
Pelvis
Long bone
Stop The
Bleeding
Manage other types of shock
accordingly

45. SUMMERY
What is shock?
Diagnosis of shock
Management of shock

46. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR
Disability

47. OBJECTIVES
Assessment
Management

48. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

49. HOW TO DO ABCDE?
Definitive
airway
A
Immediate
life-
threatening
injuries
B ShockC
Traumatic
brain injury
D ExtraE

50. ASSESSMENT
GCS
Pupils
Lateralizing sign

51. GCS

53. DISTURBED
CONSCIOU
S LEVEL
Do not assume it is related to alcohol
Do not assume it is due to haemorragic
shock
Hemorrhage is the most common case of
shock in trauma patient

54. Neurogenic
shock
Spinal shock

55. MANAGEMENT
•Neurosurgical input
•Transfer
Primary
Brain insult
•Prevent Hypoxia and hypo and
hypercarbia
•Prevent Hypotension
Secondary
Brain insult

56. HOW TO DO ABCDE?
A
•Is the airway patent
and clear?
•Is there a need for a
definitive airway?
•Is there a suspicion
of spine injury?
B
•Are there any
immediate life-
threatening injuries?
•before doing the
chest X-ray, did I
manage the
immediate life-
threatening injuries?
•What is the SO2? and
X-ray finding?
C
•Is the patient
shocked?
•Which type of shock?
•Where is the
bleeding?
D
•Is there a Traumatic
Brain Injury?
•What will I do for the
1ry insult?
•What will I do to
prevent the 2ry
insult?
E
•Is there any other
injuries?
•Am I preventing the
hypothermia?
•Am I considering my
adjuncts and re-
evaluation of the
patient?

57. INITIAL ASSESSMENT
OF TRAUMA
PATIENT
MOHAMED ALASMAR
ROCSM

58. RESTRICTION OF
CERVICAL SPINE
MOTION

59. OBJECTIVES
When to ROCSM?
How to ROCSM?
Why ROCSM?
When to clear the spine?

60. WHEN DO WE NEED TO ROCSM
Suspect Protect Detect

61. HOW TO
ROCSM?
Collar
+ protection of the whole spine with long spine board

62. CLEAR THE SPINE
Radiographic imaging may need to be used to exclude spinal injury
–usually CT scan.
It is possible to ‘clinically clear’ the spine in a conscious and fully
orientated and alert patient only.
Efforts should be made to ‘clear’ the spine as expeditiously as
possible to prevent damage to soft tissues from the board or collar.

63. WHEN TO CLEAR
THE SPINE?

64. CANADIAN C
SPINE RULES

66. OBJECTIVES
When to ROCSM?
How to ROCSM?
Why ROCSM?
When to clear the spine?

67. THANK YOU