PRIMARY CARE IN TRAUMA their management.ppt

management of trauma patients

1. PRIMARY CARE IN PRIMARY CARE IN
TRAUMATRAUMA
Dr. K.DEEPAK PAIDr. K.DEEPAK PAI
READERREADER
MAXFACSMAXFACS
A.B.S.M.I.D.SA.B.S.M.I.D.S
MANGALOREMANGALORE

2. ..............bless’d are thosebless’d are those
Whose blood and judgement are so well Whose blood and judgement are so well
co-mingledco-mingled
That they are not a pipe for fortune’s fingerThat they are not a pipe for fortune’s finger
To sound what stop she please.To sound what stop she please.
William Shakespeare (1554-1616), William Shakespeare (1554-1616),
Hamlet, III. ii Hamlet, III. ii

3. MAXFACS TRAUMA SURGEON MAXFACS TRAUMA SURGEON
IS FREQUENTLY CALLED IN IS FREQUENTLY CALLED IN
TO ASSESS AND MANAGE TO ASSESS AND MANAGE
VICTIMS OF TRAUMA EITHER VICTIMS OF TRAUMA EITHER
RTA OR OTHERWISE.RTA OR OTHERWISE.

4. A BASIC KNOWLEDGE OF A BASIC KNOWLEDGE OF
INITIAL ASSESSMENT OF INITIAL ASSESSMENT OF
THE VICTIMS IS OF THE VICTIMS IS OF
PRIME IMPORTANCE FOR PRIME IMPORTANCE FOR
PRIORITISING PRIORITISING
TREATMENT AND TREATMENT AND
PATIENT MANAGEMENT.PATIENT MANAGEMENT.

5. ESTABLISHING ASSESSMENT AND ESTABLISHING ASSESSMENT AND
MANAGEMENT PRIORITIESMANAGEMENT PRIORITIES
PATIENT ASSESSMENT AND PATIENT ASSESSMENT AND
TREATMENT PRIORITIES ARE TREATMENT PRIORITIES ARE
ESTABLISHED BASED ON THEIR ESTABLISHED BASED ON THEIR
INJURIES AND STABILITY OF THEIR INJURIES AND STABILITY OF THEIR
VITALS AND THE MECHANISM OF THE VITALS AND THE MECHANISM OF THE
TRAUMATIC INCIDENTS.TRAUMATIC INCIDENTS.

6. IMMEDIATE MORTALITY IN IMMEDIATE MORTALITY IN
TRAUMA OCCURS AT THE TRAUMA OCCURS AT THE
SCENE OF THE INJURY. SCENE OF THE INJURY.

7. THE SURGEON MUST UNDERSTAND THE SURGEON MUST UNDERSTAND
THE KINEMATICS OF TRAUMA AND THE KINEMATICS OF TRAUMA AND
INTEGRATE THIS KNOWLEDGE WITH INTEGRATE THIS KNOWLEDGE WITH
THE TRAUMA PRODUCING EPISODE.THE TRAUMA PRODUCING EPISODE.
PREHOSPITALPREHOSPITAL PERSONNELPERSONNEL ARE THE ARE THE
PRIMARY SOURCE OF THIS PRIMARY SOURCE OF THIS
IMPORTANT COMPONENT OF THE IMPORTANT COMPONENT OF THE
PATIENT’S HISTORY.PATIENT’S HISTORY.

8. HALSTEAD’S PHILOSOPHYHALSTEAD’S PHILOSOPHY
OBTAINING PATIENT AND EVENT OBTAINING PATIENT AND EVENT
HISTORY REPRESENTS 90% OF THE HISTORY REPRESENTS 90% OF THE
DIAGNOSTIC EVALUATION.DIAGNOSTIC EVALUATION.

9. “ “GOD GAVE YOU EARS,EYES AND GOD GAVE YOU EARS,EYES AND
HANDS; USE THEM ON THE PATIENT HANDS; USE THEM ON THE PATIENT
IN THAT ORDER” IN THAT ORDER”
SIR WILLIAM KELSEY FRY (1889-1963)SIR WILLIAM KELSEY FRY (1889-1963)
A LOGICAL SEQUENTIAL TREATMENT A LOGICAL SEQUENTIAL TREATMENT
PRIORITY MUST BE ESTABLISHED PRIORITY MUST BE ESTABLISHED
BASED ON OVERALL PATIENT BASED ON OVERALL PATIENT
ASSESSMENT.ASSESSMENT.

10. VITALS MUST BE ESTABLISHED VITALS MUST BE ESTABLISHED
QUICKLY AND EFFECTIVELY.QUICKLY AND EFFECTIVELY.
MANAGEMENT MUST CONSIST OF MANAGEMENT MUST CONSIST OF
RAPID PRIMARY EVALUATION, RAPID PRIMARY EVALUATION,
RESUSCITATION IF VITAL FUNCTIONS RESUSCITATION IF VITAL FUNCTIONS
AND A MORE DETAILED SECONDRY AND A MORE DETAILED SECONDRY
ASSESSMENT AND FINALLY ASSESSMENT AND FINALLY
INITIATION OF DEFINITIVE CARE.INITIATION OF DEFINITIVE CARE.

11. PRIMARY SURVEYPRIMARY SURVEY

12. ABC’sABC’s

LIFE THREATENING CONDITIONS ARE LIFE THREATENING CONDITIONS ARE
IDENTIFIED AND MANAGEMENT IDENTIFIED AND MANAGEMENT
BEGUN SIMULTANEOUSLYBEGUN SIMULTANEOUSLY ..

13. 1.1.A- AIRWAY MAINTAINANCE AND A- AIRWAY MAINTAINANCE AND
CERVICAL SPINE CONTROLCERVICAL SPINE CONTROL
2.2.B- BREATHING AND VENTILATIONB- BREATHING AND VENTILATION
3.3.C- CIRCULATION AND HEMORRHAGE C- CIRCULATION AND HEMORRHAGE
CONTROLCONTROL
4.4.D- DISABILITY AND NEUROLOGICAL D- DISABILITY AND NEUROLOGICAL
STATUSSTATUS
5.5.E- EXPOSURE: COMPLETELY E- EXPOSURE: COMPLETELY
UNDRESS THE PATIENT.UNDRESS THE PATIENT.

14. A.T.L.S.A.T.L.S.

PRIMARY SURVEY AND RESUSITATIONPRIMARY SURVEY AND RESUSITATION

SECONDARY SURVEYSECONDARY SURVEY

DEFINITIVE MANAGEMENTDEFINITIVE MANAGEMENT

15. AIRWAY MANAGEMENTAIRWAY MANAGEMENT

AIRWAY PATENCYAIRWAY PATENCY

AIRWAY MAINTENANCE TECHNIQUESAIRWAY MAINTENANCE TECHNIQUES

DEFINITIVE AIRWAYDEFINITIVE AIRWAY

16. AIRWAY CLEARANCEAIRWAY CLEARANCE

ESMARCH MANEUVER / FINGER ESMARCH MANEUVER / FINGER
SWEEPSSWEEPS

BACK BLOWSBACK BLOWS

HEIMLICH MANOEUVRE(ABDOMINAL HEIMLICH MANOEUVRE(ABDOMINAL
BLOWS)BLOWS)

LARYNGOSCOPE / FORCEPS / SUCTIONLARYNGOSCOPE / FORCEPS / SUCTION

17. AIRWAY MAINTAINANCE AIRWAY MAINTAINANCE
TECHNIQUESTECHNIQUES

CHIN LIFTCHIN LIFT

JAW THRUSTJAW THRUST

ORO-PHARYNGEAL AIRWAYORO-PHARYNGEAL AIRWAY

NASO-PHARYNGEAL AIRWAYNASO-PHARYNGEAL AIRWAY

LARYNGEAL MASKLARYNGEAL MASK

P.T.L.A.P.T.L.A.

COMI-TUBE AIRWAYCOMI-TUBE AIRWAY

18. ESTABLISHMENT OF A DEFINITIVE AIRWAY ESTABLISHMENT OF A DEFINITIVE AIRWAY
MAY REQUIRE EMERGENCY PLACEMENT OF A MAY REQUIRE EMERGENCY PLACEMENT OF A
SURGICAL AIRWAY WHEN FACIAL TRAUMA SURGICAL AIRWAY WHEN FACIAL TRAUMA
PRECLUDES OROTRACHEAL INTUBATIONPRECLUDES OROTRACHEAL INTUBATION

19. DEFINITIVE AIRWAYDEFINITIVE AIRWAY

ORO-TRACHEAL INTUBATION ORO-TRACHEAL INTUBATION

NASO-TRACHEAL INTUBATIONNASO-TRACHEAL INTUBATION

SURGICAL AIRWAY SURGICAL AIRWAY
- TRACHEOSTOMY - TRACHEOSTOMY
- -
CRICOTHYROID PUNCTURE CRICOTHYROID PUNCTURE
- -
CRICOTHYROIDOTOMYCRICOTHYROIDOTOMY

20. BREATHING BREATHING



ASSESSMENT- LOOK - RESPIRATION ASSESSMENT- LOOK - RESPIRATION RATE RATE

- TRACHEAL - TRACHEAL POSITION POSITION
- CHEST MOVEMENT - CHEST MOVEMENT
- -
AUSCULTATEAUSCULTATE
- PERCUSS- PERCUSS

TREAT - PNEUMOTHORAX (OPEN / TENSION)TREAT - PNEUMOTHORAX (OPEN / TENSION)

21. VENTILATIONVENTILATION

BASIC - MOUTH TO MOUTH BASIC - MOUTH TO MOUTH
- MOUTH TO - MOUTH TO
NOSENOSE

ADVANCED - MASK TYPE ADVANCED - MASK TYPE
- BAG TYPE - BAG TYPE
- TUBE FLANGE TYPE - TUBE FLANGE TYPE
- AUTOMATIC - AUTOMATIC
RESUSITATORSRESUSITATORS

22. CIRCULATION AND CIRCULATION AND
HAEMORRHAGE CONTROLHAEMORRHAGE CONTROL

ASSESSMENT -Source of bleeding ASSESSMENT -Source of bleeding
-Skin- color/temperature -Skin- color/temperature
capillary return capillary return
-Pulse- rate/rhythm/quality -Pulse- rate/rhythm/quality - -
Level of consciousness Level of consciousness
-Pulse pressure -Pulse pressure

MANAGEMENT- Direct Pressure MANAGEMENT- Direct Pressure
- -
I.V.Cannulation(14-16g) I.V.Cannulation(14-16g) - Blood for - Blood for
tests -FBC etc. tests -FBC etc. - Fluid replacement - Fluid replacement

23. BLOOD VOLUME AND CARDIAC BLOOD VOLUME AND CARDIAC
OUTPUTOUTPUT
RAPID ASSESSMENT OF HIS RAPID ASSESSMENT OF HIS
HEMODYNAMIC STATUS IS ESSENTIAL: HEMODYNAMIC STATUS IS ESSENTIAL:
STATE OF CONSCIOUSNESS, SKIN STATE OF CONSCIOUSNESS, SKIN
COLOR AND PULSE TO BE NOTED.COLOR AND PULSE TO BE NOTED.

24. 
CEREBRAL PERFUSION IS IMPAIRED CEREBRAL PERFUSION IS IMPAIRED
WHEN BLOOD VOLUME IS REDUCED WHEN BLOOD VOLUME IS REDUCED
TO HALF.TO HALF.

ASHEN GREY SKIN OF FACE AND ASHEN GREY SKIN OF FACE AND
WHITE SKIN OF EXTREMITIES – WHITE SKIN OF EXTREMITIES –
OMINOUS SIGNS OF HYPOVOLEMIA- OMINOUS SIGNS OF HYPOVOLEMIA-
INDICATES A BLOOD LOSS OF 30%.INDICATES A BLOOD LOSS OF 30%.

FULL SLOW REGULAR PULSE ARE A FULL SLOW REGULAR PULSE ARE A
WELCOME SIGNS IN AN INJURED WELCOME SIGNS IN AN INJURED
PERSONPERSON

25. BLEEDINGBLEEDING
1.1.EXTERNAL HEMORRAGE SHOULD BE EXTERNAL HEMORRAGE SHOULD BE
IDENTIFIED AND CONTROLLED IN IDENTIFIED AND CONTROLLED IN
PRIMARY SURVEY.PRIMARY SURVEY.
2.2.DIRECT PRESSURE AND PNEUMATIC DIRECT PRESSURE AND PNEUMATIC
SPLINTS SHOULD BE USED.SPLINTS SHOULD BE USED.
3.3.TOURNIQUETS SHOULD NOT BE TOURNIQUETS SHOULD NOT BE
USEDUSED AS THEY PRODUCE ANAEROBIC AS THEY PRODUCE ANAEROBIC
MATABOLISM.MATABOLISM.
4.4.OCCULT HEMMORRHAGE SHOULD BE OCCULT HEMMORRHAGE SHOULD BE
SUSPECTED AND CONTROLLED WITH SUSPECTED AND CONTROLLED WITH
PNEUMATIC SPLINTS. PNEUMATIC SPLINTS.

26. DISABILITY-Neurological DISABILITY-Neurological
status status

A - ALERTA - ALERT

V - RESPONSE TO VOCAL STIMULIV - RESPONSE TO VOCAL STIMULI

P - RESPONSE TO PAIN STIMULIP - RESPONSE TO PAIN STIMULI

U - UNRESPONSIVENESSU - UNRESPONSIVENESS

RECORD PUPIL SIZE AND REFLEXESRECORD PUPIL SIZE AND REFLEXES

27. EXPOSUREEXPOSURE

ALL CLOTHING SHOULD BE REMOVED.ALL CLOTHING SHOULD BE REMOVED.

HYPOTHERMIA SHOULD BE HYPOTHERMIA SHOULD BE
PREVENTED.PREVENTED.

28. Cervical Spine ControlCervical Spine Control

MANAGEMENT MANAGEMENT
- assume spine injury in - assume spine injury in
multi-system trauma multi-system trauma
- manual in-line immobilization - manual in-line immobilization
- rigid neck collars- rigid neck collars

RECOGNITION OF THE PROBLEM RECOGNITION OF THE PROBLEM
- at risk pts (drugs, - at risk pts (drugs,
drunks, head-injury, facial trauma ,etc drunks, head-injury, facial trauma ,etc

OBJECTIVE SIGNS OBJECTIVE SIGNS
-Look, listen and feel for agitation, stridor etc-Look, listen and feel for agitation, stridor etc
-Air / sand bags-Air / sand bags

29. CERVICAL SPINE RADIOGRAPH CERVICAL SPINE RADIOGRAPH
REVEALING NO FRACTURES OR REVEALING NO FRACTURES OR
SUBLUXATIONS.SUBLUXATIONS.

30. RESUSCITATION PHASERESUSCITATION PHASE
1.1.SHOCK MANAGEMENT IS INITIATED.SHOCK MANAGEMENT IS INITIATED.
2.2.MANAGEMENT OF PATIENT MANAGEMENT OF PATIENT
OXYGENATION IS RE-EVALUATED.OXYGENATION IS RE-EVALUATED.
3.3.LIFE THREATENING CONDITIONS LIFE THREATENING CONDITIONS
IDENTIFIED IN PRIMARY SURVEY IS IDENTIFIED IN PRIMARY SURVEY IS
REASSESSED AND MANAGEMENT IS REASSESSED AND MANAGEMENT IS
CONTINUED.CONTINUED.

31. TISSUE AEROBIC MATABOLISM IS TISSUE AEROBIC MATABOLISM IS
ASSURED BY ADEQUATE TISSUE ASSURED BY ADEQUATE TISSUE
PERFUSION.PERFUSION.
REPLACEMENT OF LOST VOLUME WITH REPLACEMENT OF LOST VOLUME WITH
WARMED CRYSTELLOIDS AND WARMED CRYSTELLOIDS AND
BLOODBLOOD

32. 
MANAGEMENT OF SHOCK INITIATED.MANAGEMENT OF SHOCK INITIATED.

ECG MONITORING,VITALS, BLOOD ECG MONITORING,VITALS, BLOOD
TYPING AND CROSS TYPING AND CROSS
MATCHING,URINARY AND GASTRIC MATCHING,URINARY AND GASTRIC
CATHETER PLACED IF NOT CATHETER PLACED IF NOT
CONTRAINDICATED AFTER A NASAL CONTRAINDICATED AFTER A NASAL
AND RECTAL AND GENITAL AND RECTAL AND GENITAL
EXAMINATIONEXAMINATION

33. SECONDRY SURVEYSECONDRY SURVEY

DOESN’T BEGIN UNTILL THE PRIMARY DOESN’T BEGIN UNTILL THE PRIMARY
SURVEY HAS BEEN COMPLETED AND SURVEY HAS BEEN COMPLETED AND
RESUSCITATION PHASE (MANAGEMENT RESUSCITATION PHASE (MANAGEMENT
OF LIFE THREATENING CONDITION) HAS OF LIFE THREATENING CONDITION) HAS
BEGUN.BEGUN.

IT IS THE HEAD TO TOE EVALUATION OF IT IS THE HEAD TO TOE EVALUATION OF
THE TRAUMA PATIENT INCLUDING VITAL THE TRAUMA PATIENT INCLUDING VITAL
SIGNS ASSESSMENT.SIGNS ASSESSMENT.

34. 
EXAMINE BODY BY REGIONS.EXAMINE BODY BY REGIONS.

EACH REGION IS EXAMINED EACH REGION IS EXAMINED
INDIVIDUALLY WITH HANDS AND INDIVIDUALLY WITH HANDS AND
STETHOSCOPE.STETHOSCOPE.

35. 
A NEUROLOGICAL EXAMINATION A NEUROLOGICAL EXAMINATION
INCLUDING THE GCS COMPLETES INCLUDING THE GCS COMPLETES
THE SECONDRY ASSESSMENT.THE SECONDRY ASSESSMENT.
THE CHEST AND CERVICAL SPINE THE CHEST AND CERVICAL SPINE
XRAYS ARE OBTAINED EARLY ASAP XRAYS ARE OBTAINED EARLY ASAP
B4 OTHER IMAGING EVALUATIONB4 OTHER IMAGING EVALUATION

37. CHEST RADIOGRAPH DEMONSTRATES CHEST RADIOGRAPH DEMONSTRATES
BILATERAL PULMONARY CONTUSIONS IN A BILATERAL PULMONARY CONTUSIONS IN A
TRAUMA PATIENTTRAUMA PATIENT

38. 
PERITONEAL LAVAGE, RADIOGRAPHS, PERITONEAL LAVAGE, RADIOGRAPHS,
LAB INVESTIGATIONS CONDUCTED IN LAB INVESTIGATIONS CONDUCTED IN
THIS PHASE.THIS PHASE.
SPECIAL PROCEDURES REQUIRED SPECIAL PROCEDURES REQUIRED
FOR PT. EVALUATIONFOR PT. EVALUATION

39. ORBITOFACIAL CT SCANS SHOWING ORBITOFACIAL CT SCANS SHOWING
MAXILLARY SINUS AND ZYGOMA FRACTURES MAXILLARY SINUS AND ZYGOMA FRACTURES
ON AXIAL VIEW.ON AXIAL VIEW.

40. ORBITOFACIAL CT SCANS SHOWING ORBITOFACIAL CT SCANS SHOWING
MAXILLARY SINUS AND ZYGOMA FRACTURES MAXILLARY SINUS AND ZYGOMA FRACTURES
ON CORONAL VIEW.ON CORONAL VIEW.

41. EXAMINATION OF THE EYE, EAR, NOSE, EXAMINATION OF THE EYE, EAR, NOSE,
MOUTH, RECTUM, PELVIS SHOULD NOT MOUTH, RECTUM, PELVIS SHOULD NOT
BE NEGLECTED.BE NEGLECTED.
TUBES AND FINGERS IN EVERY TUBES AND FINGERS IN EVERY
HOLE. HOLE.

42. DEFINITIVE CARE PHASEDEFINITIVE CARE PHASE

HERE ALL PATIENT INJURIES ARE HERE ALL PATIENT INJURIES ARE
MANAGED.MANAGED.

INCLUDES COMPREHENSIVE INCLUDES COMPREHENSIVE
MANAGEMENT, # MANAGEMENT, #
REDUCTION,OPERATIVE REDUCTION,OPERATIVE
INTERVENTION AND STABILISATION INTERVENTION AND STABILISATION
FOR PT. TRANSFER TO HIGHER CENTRE.FOR PT. TRANSFER TO HIGHER CENTRE.

43. OMISSION OF ANY OF THESE STEPS CAN LEAD OMISSION OF ANY OF THESE STEPS CAN LEAD
TO UNNECESSARY DISABILITY AND DEATH.TO UNNECESSARY DISABILITY AND DEATH.
ANY OBSERVATION MADE BY THE PRE-ANY OBSERVATION MADE BY THE PRE-
HOSPITAL PERSONNEL CONSERNING THE HOSPITAL PERSONNEL CONSERNING THE
PATIENT CONDITION AND MECHANISM OF PATIENT CONDITION AND MECHANISM OF
INJURY MUST BE CONSIDERED.INJURY MUST BE CONSIDERED.
CHANGES IN VITALS, RESP. AND CIRCULATION CHANGES IN VITALS, RESP. AND CIRCULATION
STATUS AND NEURO FUNCTION MUST BE STATUS AND NEURO FUNCTION MUST BE
EXPECTED.EXPECTED.

44. 1.1.HEADHEAD
1.1.EXAMINATION INITIATES THE EXAMINATION INITIATES THE
SECONDRY SURVEY.SECONDRY SURVEY.
2.2.EYES,LENS AND CONJUNCTIVA EYES,LENS AND CONJUNCTIVA
EXAMINED FOR INJURIES.EXAMINED FOR INJURIES.
3.3.QUICK VISUAL CONFRONTATION BY QUICK VISUAL CONFRONTATION BY
ASKING TO READ LABLE ON THE IV ASKING TO READ LABLE ON THE IV
BOTTLE- IDENTIFIES OCCULAR/ BOTTLE- IDENTIFIES OCCULAR/
OPTIC TRAUMA.OPTIC TRAUMA.

45. 2.MAXFACS2.MAXFACS
1.1.TRAUMA IF NOT ASSOCIATED WITH TRAUMA IF NOT ASSOCIATED WITH
AIRWAY OBSTRUCTION SHOULD BE AIRWAY OBSTRUCTION SHOULD BE
TREATED ONLY WHEN PT. IS STABLE.TREATED ONLY WHEN PT. IS STABLE.
2.2.TREATMENT SHOULD BE INITIATED TREATMENT SHOULD BE INITIATED
WITHIN 10 DAYS. WITHIN 10 DAYS.
3.3.WITH A MID FACE # N-G TUBE WITH A MID FACE # N-G TUBE
SHOULD BE PLACED VIA MOUTH IF SHOULD BE PLACED VIA MOUTH IF
SUSPECTED # OF CRIBRIFORM PLATE.SUSPECTED # OF CRIBRIFORM PLATE.

46. 3.CERVICAL SPINE3.CERVICAL SPINE
CS# PRESUMED IN ALL PTS WITH BLUNT CS# PRESUMED IN ALL PTS WITH BLUNT
MAXFACS TRAUMA.MAXFACS TRAUMA.
VISUAL AND PALPATION OF NECK IS VISUAL AND PALPATION OF NECK IS
DONE.DONE.
ABSENCE OF NEUROLOGIC DEFICIT ABSENCE OF NEUROLOGIC DEFICIT
AND PAIN DOESNOT RULE OUT AND PAIN DOESNOT RULE OUT
INJURY UNLESS RADIOLOGIC INJURY UNLESS RADIOLOGIC
EVIDENCE SHOWS OTHERWISE.EVIDENCE SHOWS OTHERWISE.

47. NON OPERATIVE MEASURES IN NON OPERATIVE MEASURES IN
EMERGENCY ROOM INCLUDES EMERGENCY ROOM INCLUDES
OBSERVATION, ARTERIOGRASPHY, OBSERVATION, ARTERIOGRASPHY,
BRONCHOSCOPY,ESOPHAGOSCOPY BRONCHOSCOPY,ESOPHAGOSCOPY
AND ESOPHAGOGRAPHY.AND ESOPHAGOGRAPHY.

48. 4.CHEST4.CHEST
1.1.VISUAL EXAMINATION TO SEE FOR VISUAL EXAMINATION TO SEE FOR
FLAIL SEGMENT.FLAIL SEGMENT.
2.2.TENDERNESS IN THE RIBS.TENDERNESS IN THE RIBS.
3.3.CONTUSIONS AND HEMATOMAS IN CONTUSIONS AND HEMATOMAS IN
THE CHEST WALL.THE CHEST WALL.
4.4.AUSCULTATE BREATH SOUNDS FOR AUSCULTATE BREATH SOUNDS FOR
ABNORMALITIES.ABNORMALITIES.
(DECREASED BREATH SOUNDS INDICATE (DECREASED BREATH SOUNDS INDICATE
CARDIAC TEMPONADE).CARDIAC TEMPONADE).

49. 5.ABDOMEN5.ABDOMEN
ANY INJURY IS POTENTIALLY ANY INJURY IS POTENTIALLY
DANGEROUS AND TREATED DANGEROUS AND TREATED
AGRESSIVELY.AGRESSIVELY.
INDIRECT PRESSURE WITH PNEUMATIC INDIRECT PRESSURE WITH PNEUMATIC
ANTISHOCK TROUSERS HELP SLOW ANTISHOCK TROUSERS HELP SLOW
CONTINUED BLOOD LOSSCONTINUED BLOOD LOSS

50. 6.RECTUM6.RECTUM
ASSESS THE PRESENCE OF BLOOD ASSESS THE PRESENCE OF BLOOD
WITHIN THE BOWEL LUMEN, HIGH WITHIN THE BOWEL LUMEN, HIGH
RIDING PROSTRATE, PELVIC #, RIDING PROSTRATE, PELVIC #,
INTEGRITY OF THE RECTAL INTEGRITY OF THE RECTAL
WALLS,AND THE QUALITY OF THE WALLS,AND THE QUALITY OF THE
SPHINCTER TONE.SPHINCTER TONE.

51. 7.FRACTURES7.FRACTURES

# OF EXTRIMITIES, CONTUSION, # OF EXTRIMITIES, CONTUSION,
DEFORMITIESDEFORMITIES

PALPATION OF THE BONES FOR PALPATION OF THE BONES FOR
ROTATIONAL MOVEMENTS, CREPITUS ROTATIONAL MOVEMENTS, CREPITUS
ETC.ETC.

OBTAIN NECESSARY RADIOGRAPHS.OBTAIN NECESSARY RADIOGRAPHS.

52. THE ANTEROPOSTERIOR PELVIS THE ANTEROPOSTERIOR PELVIS
RADIOGRAPH QUICKLY HELPS RADIOGRAPH QUICKLY HELPS
IDENTIFY MAJOR PELVIC IDENTIFY MAJOR PELVIC
FRACTURES AND JOINT FRACTURES AND JOINT
DISRUPTIONS DISRUPTIONS

53. CT SCAN OF THE ABDOMEN CT SCAN OF THE ABDOMEN
IDENTIFIES SIGNIFICANT SOFT IDENTIFIES SIGNIFICANT SOFT
TISSUE INJURY WITH HIGH TISSUE INJURY WITH HIGH
SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY

54. 8.NEUROLOGIC8.NEUROLOGIC

COMPREHENSIVE NEUROLOGICAL COMPREHENSIVE NEUROLOGICAL
MOTOR AND SENSORY EXAMINATION.MOTOR AND SENSORY EXAMINATION.

RE EVALUATE THE GCSRE EVALUATE THE GCS

IMMOBILIZATION OF THE VICTIM IMMOBILIZATION OF THE VICTIM
WITH SPINE BOARDS, CERVICAL WITH SPINE BOARDS, CERVICAL
COLARS.COLARS.

TREATMENT OF EPIDURAL AND TREATMENT OF EPIDURAL AND
SUBDURAL HEMATOMA BY SUBDURAL HEMATOMA BY
NEUROSURGEON IF INDICATED OR PT. NEUROSURGEON IF INDICATED OR PT.
IS TRANSFERED TO HIGHER CENTRE.IS TRANSFERED TO HIGHER CENTRE.

55. THE HEAD CT SCAN FOR TRAUMA IDENTIFIES SPACE-THE HEAD CT SCAN FOR TRAUMA IDENTIFIES SPACE-
OCCUPYING LESIONS AND DIRECTS OPERATIVE OCCUPYING LESIONS AND DIRECTS OPERATIVE
EVACUATION. THE LENTICULAR SHAPE OF THIS EVACUATION. THE LENTICULAR SHAPE OF THIS
LESION IDENTIFIES IT AS AN EPIDURAL HEMATOMA.LESION IDENTIFIES IT AS AN EPIDURAL HEMATOMA.

56. RE-EVALUATIONRE-EVALUATION

CONTINUOUS PROCESS TO RECORD CONTINUOUS PROCESS TO RECORD
ANY NEW DEVELOPMENTS IN HIS ANY NEW DEVELOPMENTS IN HIS
CONDITION FOR BETTER OR FOR CONDITION FOR BETTER OR FOR
WORSE.WORSE.

57. PAEDIATRIC PRIORITYPAEDIATRIC PRIORITY

BASICALLY SAME AS FOR ADULTS BASICALLY SAME AS FOR ADULTS
BUT QUANTITY OF BLOOD LOSS , AMT BUT QUANTITY OF BLOOD LOSS , AMT
OF FLUID REPLACEMENT,SIZE OF OF FLUID REPLACEMENT,SIZE OF
CHILD,DEGREE OF HEAT LOSS,AND CHILD,DEGREE OF HEAT LOSS,AND
INJURY PATTERN MAY DIFFER.INJURY PATTERN MAY DIFFER.

ASSESSMENT AND PRIORITIES ARE ASSESSMENT AND PRIORITIES ARE
THE SAME. THE SAME.

58. 
PAEDIATRIC TRAUMA SCORE IS PAEDIATRIC TRAUMA SCORE IS
USEFULL IN INDENTIFYING SEVERELY USEFULL IN INDENTIFYING SEVERELY
INJURED PTS WHO SHOULD BE INJURED PTS WHO SHOULD BE
TRANSPORTED TO A TRAUMA CENTRE.TRANSPORTED TO A TRAUMA CENTRE.

59. TRIAGETRIAGE
1.1.IT’S THE SORTING OF THE PATIENTS IT’S THE SORTING OF THE PATIENTS
BASED ON THE NEED FOR BASED ON THE NEED FOR
TREATMENT.TREATMENT.
2.2.TREATMENT IS RENDERED BASED ON TREATMENT IS RENDERED BASED ON
THE ABC PRIORITIES.THE ABC PRIORITIES.

60. PRIORITY PLAN-TREATMENT PRIORITY PLAN-TREATMENT
AND MANAGEMENTAND MANAGEMENT

61. TWO TYPES OF PRIORITISINGTWO TYPES OF PRIORITISING
THE NO. OF PATIENTS AND SEVERITY OF THE NO. OF PATIENTS AND SEVERITY OF
THEIR INJURY THEIR INJURY DOES NOTDOES NOT EXEED EXEED
THE ABILITY OF THE FACILITY TO THE ABILITY OF THE FACILITY TO
RENDER CARE- HERE PATIENTS WITH RENDER CARE- HERE PATIENTS WITH
LIFE THREATENING PROBLEMS AND LIFE THREATENING PROBLEMS AND
THOSE SUSTAINING MULTIPLE THOSE SUSTAINING MULTIPLE
SYSTEM INJURIES ARE TREATED SYSTEM INJURIES ARE TREATED
FIRST. FIRST.

63. THE NO. OF PTS AND SEVERITY OF THE NO. OF PTS AND SEVERITY OF
INJURY INJURY EXEEDSEXEEDS THE CAPABILITY OF THE CAPABILITY OF
THE FACILITY AND STAFF- HERE THE THE FACILITY AND STAFF- HERE THE
PTS WITH THE GREATEST CHANCES PTS WITH THE GREATEST CHANCES
OF SURVIVAL AND LEAST OF SURVIVAL AND LEAST
EXPENDITURE OF TIME, EQUIPMENT, EXPENDITURE OF TIME, EQUIPMENT,
SUPPLIES AND MAN POWER ARE SUPPLIES AND MAN POWER ARE
MANAGED FIRST. MANAGED FIRST.

64. WATERS VIEW WATERS VIEW

65. CALDWELL CALDWELL
VIEW VIEW

66. LATERAL LATERAL
VIEW. VIEW.

67. BASE OR SUBMENTAL VIEW. BASE OR SUBMENTAL VIEW.

68. TRAUMA RESUSCITATIONS INVOLVING TRAUMA RESUSCITATIONS INVOLVING
SIMULTANEOUS DIAGNOSIS AND SIMULTANEOUS DIAGNOSIS AND
TREATMENT BY MULTIPLE PROVIDERS TREATMENT BY MULTIPLE PROVIDERS
DEMAND LEADERSHIP AND DEMAND LEADERSHIP AND
ORGANIZATION TO FUNCTION ORGANIZATION TO FUNCTION
EFFECTIVELY.EFFECTIVELY.

69. PERIORBITAL ECCHYMOSIS, OR PERIORBITAL ECCHYMOSIS, OR
"RACCOON EYES," IS A CLASSIC "RACCOON EYES," IS A CLASSIC
DIAGNOSTIC SIGN OF BASILAR DIAGNOSTIC SIGN OF BASILAR
SKULL FRACTURE. SKULL FRACTURE.

70. SUMMARYSUMMARY

EVALUATION SHOULD BE RAPID AND EVALUATION SHOULD BE RAPID AND
THOROUGH.THOROUGH.

DEVELOP PRIORITIES FOR THE VICTIM.DEVELOP PRIORITIES FOR THE VICTIM.

PRIORITY HELPS TO AVOID OMISSION PRIORITY HELPS TO AVOID OMISSION
OF ANY STEPS.OF ANY STEPS.

ADEQUATE PATIENT HISTORY AND ADEQUATE PATIENT HISTORY AND
ACCOUNTING OF THE INCIDENCE ACCOUNTING OF THE INCIDENCE
HELPS MANAGING THE VICTIM.HELPS MANAGING THE VICTIM.

71. EVALUATION AND CARE IS DIVIDED EVALUATION AND CARE IS DIVIDED
INTO 5 PHASES:INTO 5 PHASES:
1.1.PRIMARY SURVEYPRIMARY SURVEY
2.2.RESUSCITATIONRESUSCITATION
3.3.SECONDRY SURVEY- TOTAL SECONDRY SURVEY- TOTAL
EVALUATION OF THE PATIENTS.EVALUATION OF THE PATIENTS.
4.4.DEFINITIVE CAREDEFINITIVE CARE
5.5.TRANSFERTRANSFER

72. PRIMARY SURVEYPRIMARY SURVEY
ASSESSMENT OF :ASSESSMENT OF :
1.1.AIRWAYAIRWAY
2.2.BREATHINGBREATHING
3.3.CIRCULATIONCIRCULATION
4.4.DISABILITY AND NEUROLOGIC DISABILITY AND NEUROLOGIC
EVALUATIONEVALUATION
5.5.EXPOSUREEXPOSURE

73. RESUSCITATIONRESUSCITATION
1.1.SHOCK MANAGEMENT- INTRA SHOCK MANAGEMENT- INTRA
VENOUS LINES AND RINGER’S VENOUS LINES AND RINGER’S
LACTATELACTATE
2.2.MGNT OF LIFE THREATENING MGNT OF LIFE THREATENING
PROBLEMS IDENTIFIED IN PRIMARY PROBLEMS IDENTIFIED IN PRIMARY
SURVEY IS CONTINUEDSURVEY IS CONTINUED
3.3.ECG MONITORINGECG MONITORING

74. SECONDRY SURVEY- TOTAL SECONDRY SURVEY- TOTAL
EVALUATION OF THE PATIENTSEVALUATION OF THE PATIENTS
1.1.HEAD AND SKULLHEAD AND SKULL
2.2.MAXFACS INJURIESMAXFACS INJURIES
3.3.NECKNECK
4.4.CHESTCHEST
5.5.ABDOMENABDOMEN
6.6.PERINEUM /RECTUMPERINEUM /RECTUM
7.7.EXTREMITIES-FRACTURESEXTREMITIES-FRACTURES
8.8.COMPLETE NEUROLOGICAL EXAMINATIONCOMPLETE NEUROLOGICAL EXAMINATION
9.9.APPROPRIATE X-RAYS, LAB TESTS, AND SPECIAL APPROPRIATE X-RAYS, LAB TESTS, AND SPECIAL
STUDIESSTUDIES
10.10.““TUBES AND FINGERS IN EVERY ORIFICE”TUBES AND FINGERS IN EVERY ORIFICE”

75. DEFINITIVE CAREDEFINITIVE CARE
BEGINS AFTER IDENTIFYING PATIENT BEGINS AFTER IDENTIFYING PATIENT
INJURIES, LIFE THREATENING INJURIES, LIFE THREATENING
PROBLEMS, AND OBTAINING PROBLEMS, AND OBTAINING
SPECIAL STUDIES.SPECIAL STUDIES.

76. TRANSFERTRANSFER
IF THE PATIENTS INJURIES EXEEDS THE IF THE PATIENTS INJURIES EXEEDS THE
INSTITUTIONS IMMEDIATE TREATMENT INSTITUTIONS IMMEDIATE TREATMENT
CAPABILITIES. THE PROCESS OF CAPABILITIES. THE PROCESS OF
TRANSFERING THE PATIENT IS INITIATED TRANSFERING THE PATIENT IS INITIATED
ASAP.ASAP.
DELAY IN TRANSFERRING THE PATIENT TO DELAY IN TRANSFERRING THE PATIENT TO
A HIGHER LEVEL OF CARE SIGNIFICANTLY A HIGHER LEVEL OF CARE SIGNIFICANTLY
INCREASES THE PATIENT’S RISK OF INCREASES THE PATIENT’S RISK OF
MORTALITY.MORTALITY.

77. ““From inability to let well alone;From inability to let well alone;
from too much zeal for the new and contempt for what from too much zeal for the new and contempt for what
is old;is old;
from putting knowledge before wisdom, science before from putting knowledge before wisdom, science before
art, and cleverness before common sense;art, and cleverness before common sense;
from treating patients as cases;from treating patients as cases;
and from making the cure of the disease more grievous and from making the cure of the disease more grievous
than the endurance of the same, Good Lord, deliver than the endurance of the same, Good Lord, deliver
us”us”
Sir Robert Hutchison (1871-1960)Sir Robert Hutchison (1871-1960)