Polytrauma

polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU

1. by:- Hasanain g. Khudhair ( [email protected] ) Mays salim Mahdi Zahraa Salman yaas Kerbala university / college of medicine department of surgery 10-9-2017 polytrauma

2. polytrauma

3. Objective: 1-defenition 2-epidemiology 3-etiology 4-pathophysiology 5-type of shock in polytrauma 6-Mangment

4. definition Polytrauma is a significant injury in at least two of the following six body regions: Head , neck and cervical spine Face Chest and thoracic spine Abdomen and lumbar spine Limbs and bony pelvis External (skin) Significant injury in AIS> =3

5. Abbreviated injury score AIS >=3 injury severity score ISS >=16

6. The defenition of polytrauma expanded to include concurrent injury to two or more body parts or systems that result in cognitive ,physical ,psychological or other psychosocial impairment. Ex : TBI in combination with other disabiling condition like amputation,auditory or visual impairment, PTSD and other mental condition

7. Criteria of polytrauma include any one of the following combination injury Two major system injury + one major limb injury One major system injury +two major limb injury One major system injury + one open grade 3 skeletal injury Unstable pelvis # with associated visceral injury

8. Etiology of polytrauma RTA Fall from height (blunt or penetrating injury) Assault- اعتداء Airplane crashes ,train derailment Blast Thermal ,chemical injury

9. Polytrauma is the third most common cause of death in all age group . 1-first peak-major neurological or vascular injury 2-second peak-intracranial hematoma , major thoracic or abdominal injury 3-third peak-sepsis and multiple organ fail

10. pathophysiology of polytrauma : is complex phenomenon aiming at the restoration of homeostasis and preservation of life

11. SIRS

12. Type of shock in polytraumatized patient 1.Hemorrhagic shock duo to loss blood voulme ,diagnosis based on vital sign and examination characterized by hypotention tachycardia and cold skin 2.neurogenic shock duo to spinal cord injury that causes distribution of sympathetic outflow to heart and blood vessles characterized by hpotention . bradycardia .warm skin 3.hypoxic shock 4.septic shock

13. Phases of trauma care 1.prehospital care 2.emergency department 3.Rehabilitation Prehospital care: TRIAGE Sorting and allocation of treatment to patient according the urgency of their need for care Should be performed rapidly

14. How to start triage

15. ATLS Primary survey Identify what is killing the patient. Resuscitation Treat what is killing the patient. Secondary survey Proceed to identify other injuries. Definitive care Develop a definitive management plan .

16. ATLS- PRIMARY SURVEY A – Airway maintenance & control of C.Spine. B – Breathing & ventilation. C – Circulation & haemorrhage control D – Disability limitation E –Exposure & environment. F – Fracture stabilization, folly catheter .

17. ATLS- PRIMARY SURVEY A – Airway maintenance & Control of C.Spine If conscious- Ask the pt’s name If unconscious-Look for added sounds (stridor,cyanosis etc) If the pt does not respond to any questions- resuscitate. Always assume a cervical spine injury is present

18. ATLS- PRIMARY SURVEY A - A IRWAY Sequence of events: chin lift Jaw thrust finger sweep suction Oropharyngeal/ orotrachial tube Cricothyroidotomy Trachiostomy

19. Primary Survey B - B reathing & ventilation Exposure Inspection Auscultation Palpation Pulse oximetry The aim is to hunt out & treat the life threatening thoracic condns which include :

20. Primary Survey B - B reathing & ventilation life threatening thoracic conditions : Tension Pneumothorax Open pneumothorax Flail segment Cardiac tamponade

21. Primary Survey B - B reathing & ventilation Tension pneumothorax C / F Respiratory distress Tracheal deviation Diminished breath sounds Distended neck veins Immediate needle thoracocentesis thro’ 2 nd intercostal space in mid clavicular line reqd.

22. Primary Survey B- Breathing & ventilation Open pneumothorax : Sealing of the wound Tube thoracostomy Flail segment: E nd o t r ach i a l intubation Mechanical ventilation

23. Primary Survey B- Breathing & ventilation Cardiac tamponade (almost always seen with a penetrating wound) Beck’s triad: Treatment: needle pericardiocentes Thoracotomy

24. ATLS- Primary Survey C - C irculation and hemorrhage control Assessment of blood loss External or obvious Internal or covert chest ab d o m e n pelvis limbs Resuscitation Arrest bleeding Obtain vascular access

25. ATLS- Primary Survey C- C irculation and hemorrhage control Adults- 2 lit of Ringer lact soln as initial fluid challenge Children- 20mg/kg of body wt Response to initial fluid challenge : Immediate & sustained return of vital signs. Transient response with later deterioration No improvement .

26. ATLS- Primary Survey C- C irculation and hemorrhage control Immediate responders- <20% blood loss Bleeding ceases spontaneously Transient responders- bleeding within body cavities Surgical intervention reqd . Non responders - < 40 % of blood vol lost require immediate surgery Continued IV fluids detrimental

27. ATLS- Primary Survey C- Circulation and hemorrhage control Estimation of blood loss

28. ATLS- Primary Survey D - D isability limitation C.N.S. Rapid assessment of motor & sensory functions AVPU A .-Alert V .-Responds to Voice P .-Responds to Pain U . - U n r e s p o n s i ve Pupil.-Size and reaction

29. ATLS- Primary Survey D- Disability limitation Remove remaining clothing Prevent hypothermia

30. CRITICAL DECISIONS Decision making  Responding well Secondary a ss e ssme n t  Transient responders Critical care unit  Failure to respond Critical care unit

31. Secondary survey (ATLS) History Examination Investigation

32. Secondary survey (ATLS) HEAD NECK THORAX ABDOMIN SPINAL INJURY