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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

Overview of Trauma

Maggie Gordon R2

July 9, 2007

initial assessment and management
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
walk into room
Walk into room
  • Orders
    • Monitors
    • O2
    • IV
  • r/o tension pneumothorax
initial assessment and management4
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
primary survey and resuscitation
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
primary survey and resuscitation6
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
airway with c spine protection
Airway with C-spine Protection
  • Endotracheal tube purposes:
    • Airway
    • O2
    • Ventilation
    • Prevent aspiration
airway with c spine protection8
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 resuscitation9
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
breathing
Breathing
  • Auscultation
  • Percussion
  • Diagnose and treat
    • Tension pneumothorax
    • Massive hemothorax
primary survey and resuscitation11
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
circulation
Circulation
  • Diagnose and treat massive bleeding from / into:
    • Chest
    • Abdomen
    • Pelvis
    • Long bones
  • IV access, fluids
primary survey and resuscitation13
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
disability
Disability
  • Quick neuro exam
    • GCS
    • Pupils
  • Glasgow Coma Scale
primary survey and resuscitation15
Primary Survey and Resuscitation
  • Airway with C-spine protection
  • Breathing
  • Circulation
  • Disability
  • Exposure, Environment
exposure environment
Exposure, Environment
  • Cut off clothing
  • Keep patient warm
    • Warm IV fluids
    • Warm flannels
    • Bear huggers
initial assessment and management17
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
adjuncts to primary survey
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 management19
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
secondary survey
Secondary Survey
  • Head and skull
  • Maxillofacial and intra-oral
  • Neck
  • Chest
  • Abdomen
  • Back
  • Perineum, rectum, vagina
  • MSK
  • Neuro
initial assessment and management21
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
adjuncts to secondary survey
Adjuncts to Secondary Survey
  • CT
  • Contrast X-rays
  • Extremity X-rays
  • Endoscopy
  • US
initial assessment and management23
Initial Assessment and Management
  • Primary survey and resuscitation
  • Adjuncts to 1° survey
  • Secondary survey
  • Adjuncts to 2° survey
  • Definitive Care
definitive care
Definitive Care
  • Consults
  • Transfer
case 1
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
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
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
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
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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