Trauma

"TRAUMA"

1. TRAUMA Submitted By: Preeti Sood MSc Nursing 1 st Year

2. Trauma Terminology: Injury = The result of harmful event that arises from the release of specific forms of energy. “ T rauma ” = I njury of one or more systems, that results in excessive bleeding and may affect the normal body functioning.

3. EPIDEMIOLOGY 3242 persons die each day around the world. 50 million people are disabled or injured each year. India : 1%of motor vehicles in the world but bears the burden of 6% of global vehicular accidents. Unfortunately, a majority of trauma survivors are either confined to bed or wheel chair for the rest of their lives. The tragedy of India : 78 % of the victims – men, 20 to 44 years, causing significant impact on productivity. A vehicular accident reported every 3 min and a death every 6 min on Indian roads

4. TRAUMA TEAM

5. Trauma deaths FIRST PEAK Within minutes of injury Due to major neurological or vascular injury Medical treatment can rarely improve outcome SECOND PEAK Occurs during the 'golden hour' Due to intracranial haematoma, major thoracic or abdominal injury Primary focus of intervention for the Advanced Trauma Life Support (ATLS) methodology THIRD PEAK Occurs after days or weeks Due to sepsis and multiple organ failure

6. Trauma Preparation and triage Primary Survey Adjuncts to primary survey Secondary Survey Adjuncts to secondary survey Definitive treatment Records, Consent, Forensic evidence

7. Preparation and Triage

8. Triage

9. The process of categorizing victims or mass casualties based on their need for treatment and the resources available . ITS MAIN GOALS ARE: Prevent avoidable deaths. Ensure proper initial treatment with a minimal time frame. Avoid misusing asserts on hopeless cases.

10. MULTIPLE CASUALTIES No . of patients and the severity of their injuries do not exceed the ability of the facility to provide care. MASS CASUALTIES The no. of patients and the severity of their injuries exceed the ability of the facility to provide care.

11. Assessment of the injured patient Primary survey and resuscitation A = Airway and cervical spine B = Breathing C = Circulation and hemorrhage control D = Disability or Dysfunction of the central nervous system E = Exposure

12. Airway and cervical spine Always assume that patient has cervical spine injury If patient can talk then he is able to maintain own airway If airway compromised initially attempt a chin lift and clear airway of foreign bodies. Intubate or cricothyroidotomy Give 100% Oxygen

13. Breathing Check position of trachea, respiratory rate and air entry If clinical evidence of tension pneumothorax will need immediate relief Place venous cannula through second intercostal space in the mid- clavicular line If open chest wound seal with occlusive dressing

14. Circulation and hemorrhage control Assess pulse, capillary return and state of neck veins Identify exsanguinating hemorrhage and apply direct pressure. Place two large calibre intravenous cannulas Give intravenous fluids Attach patient to ECG monitor

15. Disability or Dysfunction of the central nervous system Rapid assessment of neurologic status to identify life-threatening injury Pupil size and response Mental status ( Glasscow coma scale) Motor and sensory exam

16. E xposure Head to toe examination of the patient for injury Pitfalls - Maintenance of spine precautions - Prevention of heat loss - Under cervical collar Back and flanks Undress the patient completely but prevent hypothermia. Logrolling and looking for back of the pt. is very important

17. Adjuncts to the Primary Survey Exams during or after primary survey to aid in identifying life-threatening injuries ECG Pulse oximetry Chest x-ray Pelvis x-ray ABGS Catheters - Focused abdominal sonogram for trauma (FAST) Diagnostic peritoneal lavage (DPL ) Resuscitation may be required in some cases.

18. Secondary survey Secondary survey does not begin until the primary survey is completed, resuscitative efforts are established and patient is demonstrating normalization of vital functions. It includes: Head to toe evaluation AMPLE history - Allergy - Medications currently taking - Past illness - Last meal - Event/environment related to injury. Physical examination Reassessment of all vital organs

19. Adjuncts to the secondary survey CT SCAN CONTRAST STUDIES EXTREMITY XRAY ENDOSCOPY ULTRASONOGRAPHY

20. Definitive Treatment Treatment plans, especially for multiple injuries, based on clinical status and specific injuries. AFTER identifying the patients injury. Managing life threatening problems Obtaining special studies. If the patients injuries exceed the capabilities of the institution.

21. Take home message ABCDE approach. Treat greatest threat to life. Definitive diagnosis is not immediately important. Time is the essence. Do no further harm the patient.