Overview of Trauma

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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
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Walk into room
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Orders
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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
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Primary Survey and Resuscitation
Airway with C-spine protection
 Breathing
 Circulation
 Disability
 Exposure, Environment
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Airway with C-spine Protection
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Endotracheal tube purposes:
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Airway
O2
Ventilation
Prevent aspiration
Airway with C-spine Protection
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Need airway protection:
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Decreased LOC, including agitated
Face, neck trauma
Aspiration risk – bleeding, vomiting
Need ventilation
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Apnea
Inadequate respiration
Head injury requiring hyperventilation
Primary Survey and Resuscitation
Airway with C-spine protection
 Breathing
 Circulation
 Disability
 Exposure, Environment
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Breathing
Auscultation
 Percussion
 Diagnose and treat
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Tension pneumothorax
Massive hemothorax
Primary Survey and Resuscitation
Airway with C-spine protection
 Breathing
 Circulation
 Disability
 Exposure, Environment
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Circulation
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Diagnose and treat massive bleeding
from / into:
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Chest
Abdomen
Pelvis
Long bones
IV access, fluids
Primary Survey and Resuscitation
Airway with C-spine protection
 Breathing
 Circulation
 Disability
 Exposure, Environment
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Disability
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Quick neuro exam
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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
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Exposure, Environment
Cut off clothing
 Keep patient warm
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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
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Monitoring
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Sats
BP
Blood-work – “trauma panel”
End-tidal CO2
ECG
ABG
Foley (quick rectal first), NGT
 X-rays, diagnostic studies
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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
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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
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Initial Assessment and Management
Primary survey and resuscitation
 Adjuncts to 1° survey
 Secondary survey
 Adjuncts to 2° survey
 Definitive Care

Definitive Care
Consults
 Transfer
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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
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Case 2
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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%
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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%
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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.
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