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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 O 2 IV r/o tension pneumothorax.

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Overview of Trauma

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Overview of trauma l.jpg

Overview of Trauma

Maggie Gordon R2

July 9, 2007


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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

  • Orders

    • Monitors

    • O2

    • IV

  • r/o tension pneumothorax


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Initial Assessment and Management

  • Primary survey and resuscitation

  • Adjuncts to 1° survey

  • Secondary survey

  • Adjuncts to 2° survey

  • Definitive Care


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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

  • Endotracheal tube purposes:

    • Airway

    • O2

    • Ventilation

    • Prevent aspiration


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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


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Primary Survey and Resuscitation

  • Airway with C-spine protection

  • Breathing

  • Circulation

  • Disability

  • Exposure, Environment


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Breathing

  • Auscultation

  • Percussion

  • Diagnose and treat

    • Tension pneumothorax

    • Massive hemothorax


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Primary Survey and Resuscitation

  • Airway with C-spine protection

  • Breathing

  • Circulation

  • Disability

  • Exposure, Environment


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Circulation

  • Diagnose and treat massive bleeding from / into:

    • Chest

    • Abdomen

    • Pelvis

    • Long bones

  • IV access, fluids


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Primary Survey and Resuscitation

  • Airway with C-spine protection

  • Breathing

  • Circulation

  • Disability

  • Exposure, Environment


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Disability

  • Quick neuro exam

    • GCS

    • Pupils

  • Glasgow Coma Scale


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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

    • Warm IV fluids

    • Warm flannels

    • Bear huggers


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Initial Assessment and Management

  • Primary survey and resuscitation

  • Adjuncts to 1° survey

  • Secondary survey

  • Adjuncts to 2° survey

  • Definitive Care


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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


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Initial Assessment and Management

  • Primary survey and resuscitation

  • Adjuncts to 1° survey

  • Secondary survey

  • Adjuncts to 2° survey

  • Definitive Care


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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


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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


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Definitive Care

  • Consults

  • Transfer


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Cases


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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

  • 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%.


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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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