Overview of Trauma
Download
Report
Transcript Overview of Trauma
Overview of Trauma
Maggie Gordon R2
July 9, 2007
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Walk into room
Orders
Monitors
O2
IV
r/o tension pneumothorax
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Airway with C-spine Protection
Endotracheal tube purposes:
Airway
O2
Ventilation
Prevent aspiration
Airway with C-spine Protection
Need airway protection:
Decreased LOC, including agitated
Face, neck trauma
Aspiration risk – bleeding, vomiting
Need ventilation
Apnea
Inadequate respiration
Head injury requiring hyperventilation
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Breathing
Auscultation
Percussion
Diagnose and treat
Tension pneumothorax
Massive hemothorax
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Circulation
Diagnose and treat massive bleeding
from / into:
Chest
Abdomen
Pelvis
Long bones
IV access, fluids
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Disability
Quick neuro exam
GCS
Pupils
Glasgow Coma Scale
Eye opening
Verbal
Motor
1 none
none
none
2 to pain
sounds
decerebrate
3 to sound
words
decorticate
4 spontaneous
confused
withdraws
5
oriented
purposeful
6
to command
Primary Survey and Resuscitation
Airway with C-spine protection
Breathing
Circulation
Disability
Exposure, Environment
Exposure, Environment
Cut off clothing
Keep patient warm
Warm IV fluids
Warm flannels
Bear huggers
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Adjuncts to Primary Survey
Monitoring
Sats
BP
Blood-work – “trauma panel”
End-tidal CO2
ECG
ABG
Foley (quick rectal first), NGT
X-rays, diagnostic studies
Chest, pelvis, C-spine
FAST / DPL
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Secondary Survey
Head and skull
Maxillofacial and intra-oral
Neck
Chest
Abdomen
Back
Perineum, rectum, vagina
MSK
Neuro
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Adjuncts to Secondary Survey
CT
Contrast X-rays
Extremity X-rays
Endoscopy
US
Initial Assessment and Management
Primary survey and resuscitation
Adjuncts to 1° survey
Secondary survey
Adjuncts to 2° survey
Definitive Care
Definitive Care
Consults
Transfer
Cases
Case 1
26 y.o. F. MVA at 60km/h, hit a brick
wall while swerving. Wearing seatbelt.
Airbags deployed. No LOC. In C-collar,
on spine board.
Healthy, no allergies, only med is BCP
Case 2
18 y.o. M. Unbelted, thrown from
convertible when it rolled. Brought by
helicopter in C-collar and on spine board.
GCS 3 the entire time. Intubated on the
scene. BP 145/75, HR 50, sats 99%.
Case 3
52 y.o. M. Driving motorcycle, struck by
SUV. In C-collar, on spine board. Helmet
removed by EMS at scene. GCS 14 entire
time.
Healthy, no allergies, no medications
HR 120, BP 95/55, RR 18, sats 100%
Case 4
26 y.o. M. Shot in abdomen. GCS 14
entire time.
Healthy, no allergies, no medications
HR 120, BP 95/55, RR 18, sats 100%
Case 5 (ER Case)
You are driving along Lakshore Blvd. You
witness a 30 y.o. F bicyclist struck by car.
Very anxious, respiratory distress, no
obvious blood, L femur deformed.