Trauma
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Trauma. Leading cause of death & disability. Till forty. Hassan Ravari MD Associated Professor of Vascular Surgery Mashhad-Imam Reza Hospital Department of vascular surgery. /. No vital signs. No signs of life. A Airway ( cervical spine protection) B Breathing

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Trauma

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Trauma

Trauma

Leading cause of death & disability

Till forty

Hassan Ravari MD

Associated Professor of Vascular Surgery

Mashhad-Imam Reza Hospital

Department of vascular surgery


Trauma

/

No vital signs

No signs of life


Trauma

  • A Airway ( cervical spine protection)

  • B Breathing

  • C Circulation (control of external - bleeding)


Trauma

Airway obstruction

The leading cause of death

at the accident site


Trauma

Foreign body


Trauma

Mouth-to-Mouth

Ventilation


Trauma

Endotracheal Intubation

GCS < 8

RR > 35/min

P O2 < 60 mmHg

P CO2 > 50 mmHg


Trauma

Elective Intubation

Extensive neck emphysema

Burn of the airway

Airway bleeding

Expanding neck hematoma


Trauma

Surgical

Cricothyroidotomy


Trauma

Needle

Cricothyroidotomy


Trauma

Multiple trauma

requiring oxygen

twice normal


Trauma

Carotid P. = 60 mmHg

Femoral P. = 70 mmHg

Radial P. = 80 mmHg


Trauma

Etiology of shock after trauma:

Tension pneumothorax

Cardiac tamponade

Massive hemothorax

Heart contusion


Trauma

Etiology of shock after trauma:

Cont.

Air embolism

Great vessel inj.

Ruptured diaphragm

Pulmonary contusion


Trauma

Cardiac

Massage


Trauma

Shock

Position


Trauma

Tension pneumothorax

a clinical diagnosis


Trauma

Chest pain

Dilated neck veins

Absent breath sound


Trauma

Needle aspiration


Trauma

Ant. A.L

Mid. A.L

Chest tube


Trauma

Chest tube


Trauma

Open pneumothorax

Taped on three sides


Trauma

Tamponade


Trauma

Pericardiocentesis


Trauma

IV Line at the scene


Trauma

Trauma team

Leader


Trauma

Crystalloid or colloid

Ringer lactate


Trauma

Suspicious to internal bleeding

(Hypotensive Resuscitation)

(Controlled Hypotension)


Trauma

Blood

Ringer 1 lit. bolus

( 20 cc/kg child )

Repeated if needed


Trauma

Estimated blood loss

(Fx)

Humerus 0.5-1.5 lit.

Tibia 0.5-1.5 lit.

Femur 1-2.5 lit.

Pelvis 1-4 lit.


Trauma

Immobilization


Trauma

Immobilization


Trauma

All injured patients have spine instability

until proved otherwise


Trauma

Every patient has a Back

as well as a Front

NG tube

Foley catheter


Trauma

No NG tube:

Maxillofascial Fx

Base of skull Fx

Penet. inj. of the neck

Cervical spine Fx


Trauma

No Urinary catheter:

Blood on meatus

Scrotal hematoma

Perineal hematoma

Floating prostate

High riding prostate


Trauma

High-velosity gunshot inj.

Almost-always require operation

Almost-always require operation


Trauma

Penetrating injury

Neck

Back

Flank


Trauma

Concomitant

Thoracoabdominal

injury


Trauma

Antibiotic

Keflin 1g Q6h IV


Trauma

Analgesic:

Limb Fx

Rib Fx


Trauma

No analgesic:

CNS observation


Trauma

The radiology department is a dangerous place

Is the investigation essential ?

Is the patient stable ?


Trauma

X-ray in all major trauma:

1-Cervical spine (lat.)

2-Chest (PA)

3-Pelvis (PA)


Trauma

Preventing hypothermia :

Warm fluids

Heating pads

Warm environment


Trauma

Restlessness & confusion

is due to Hypoxemia

Until proven otherwise


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