Critically injured patient
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Critically injured patient. Prof Mohan de Silva. Essential words to remember. TRIMODAL distribution of deaths ATLS Primary survey Secondary survey. The Critically Injured. Trauma commonest cause of hospital admissions in Sri Lanka since 1995

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Critically injured patient

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Critically injured patient

Prof Mohan de Silva


Essential words to remember

  • TRIMODAL distribution of deaths

  • ATLS

  • Primary survey

  • Secondary survey


The Critically Injured

Trauma

  • commonest cause of hospital admissions

    in Sri Lanka since 1995

  • commonest cause of death below the

    age of 40 in many countries


The critically injured

  • Majority died due to inadequate

    treatment

  • Initial treatment determines the

    outcome

  • Early intervention is essential


GOLDEN HOUR OF TRAUMA


TRIMODAL DISTRIBUTION OF DEATHS

  • Immediate

  • 1st few hours

  • Few days after admission


Conventional approach

  • History

  • Examination

  • Investigations

  • Diagnosis

  • Treatment


How it all startedAnother accident ………..


New approach… A T L S

  • Initial assessment ( History,

    Examination )

    Resuscitation ( Treatment )

    WILL BEGIN SIMALTANEOUSLY

  • Recognize and treat the most life

    threatening injury first


TRAUMA KILLS ACCORDING TO A

SEQUENCE !

  • Acute airway obstruction

    - The quickest killer

  • Inadequate breathing

  • Hypovolaemia

  • Expanding intra cranial

    haematoma


  • Hypoxia and Hypovolaemia

    are the main killers

  • Hypoxia kills before

    hypovolaemia


  • PRIMARY SURVEY

  • SECONDARY SURVEY


Initialassessment and resuscitation Primary survey

  • Air way with cervical spine control

  • Breathing

  • C irculation

  • Disability (Neurological )

  • Exposure

  • Foleys catheter


Airway obstruction recognition and treatment

  • Identify – SPEAK TO THE PATIENT

  • establish OXYGEN

  • protect OXYGEN

  • maintain OXYGEN

    10 L / minute


Immobilisation of the C spine

  • sand bag

  • collar

  • tape


B reathing

  • Inspection - wall movements,ext.

    injuries etc

  • Palpation - cripitus

  • percussion - hyperesonence

    or stony dullness

  • Auscultation - breath sounds

    absent

    RESPIRATORY RATE


Circulation

All critically injured patients are in

hypovolaemic shockAction PULSE RATE , B P

  • 2 Big drips to Two big veins

  • 2 L of N Saline fast in

  • Blood cross matching


D isability (Neurological )

  • A V P U

  • Glasgow coma score

  • Expose the patient

    Where is the scissor !


Secondary survey

Pulse - BP – RR -Temperature

  • Systematic examination from head

    to toe

  • LOG ROLL

  • Finger to all orifices

  • Minor injuries


HistoryA M P L E

  • A llergies

  • M edications

  • P ast illnesses

  • L ast meal

  • E vents leading to the injury


Outcome

  • ?

  • ?

  • ?


TAKE HOME MESSAGE

  • What is the first thing you do when you get a critically injured ?

  • What is the quickest killer of the injured?

  • What is trimodal distribution of deaths?

  • What is the difference between conventional and ATLS approach

  • What do you do in Primary and secondary surveys?


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