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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

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

  • C Circulation (control of external - bleeding)


Airway obstruction

The leading cause of death

at the accident site



Mouth-to-Mouth

Ventilation


Endotracheal Intubation

GCS < 8

RR > 35/min

P O2 < 60 mmHg

P CO2 > 50 mmHg


Elective Intubation

Extensive neck emphysema

Burn of the airway

Airway bleeding

Expanding neck hematoma


Surgical

Cricothyroidotomy


Needle

Cricothyroidotomy


Multiple trauma

requiring oxygen

twice normal


Carotid P. = 60 mmHg

Femoral P. = 70 mmHg

Radial P. = 80 mmHg


Etiology of shock after trauma:

Tension pneumothorax

Cardiac tamponade

Massive hemothorax

Heart contusion


Etiology of shock after trauma:

Cont.

Air embolism

Great vessel inj.

Ruptured diaphragm

Pulmonary contusion


Cardiac

Massage


Shock

Position


Tension pneumothorax

a clinical diagnosis


Chest pain

Dilated neck veins

Absent breath sound



Ant. A.L

Mid. A.L

Chest tube



Open pneumothorax

Taped on three sides





Trauma team

Leader


Crystalloid or colloid

Ringer lactate


Suspicious to internal bleeding

(Hypotensive Resuscitation)

(Controlled Hypotension)


Blood

Ringer 1 lit. bolus

( 20 cc/kg child )

Repeated if needed


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.





Every patient has a Back

as well as a Front

NG tube

Foley catheter


No NG tube:

Maxillofascial Fx

Base of skull Fx

Penet. inj. of the neck

Cervical spine Fx


No Urinary catheter:

Blood on meatus

Scrotal hematoma

Perineal hematoma

Floating prostate

High riding prostate


High-velosity gunshot inj.

Almost-always require operation

Almost-always require operation


Penetrating injury

Neck

Back

Flank


Concomitant

Thoracoabdominal

injury


Antibiotic

Keflin 1g Q6h IV


Analgesic:

Limb Fx

Rib Fx


No analgesic:

CNS observation


The radiology department is a dangerous place

Is the investigation essential ?

Is the patient stable ?


X-ray in all major trauma:

1-Cervical spine (lat.)

2-Chest (PA)

3-Pelvis (PA)


Preventing hypothermia :

Warm fluids

Heating pads

Warm environment


Restlessness & confusion

is due to Hypoxemia

Until proven otherwise


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