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Management Of Multiply Injured Patients

Management Of Multiply Injured Patients. By: Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB. Trauma. Trauma claims the life of millions every year. Mostly it affects young age group-the productive section of society.

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Management Of Multiply Injured Patients

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  1. Management Of Multiply Injured Patients By: Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB

  2. Trauma • Trauma claims the life of millions every year. • Mostly it affects young age group-the productive section of society. • Visit Trauma.org and look at the instantly changing no.of mortality due to trauma. TIME NOW TRAUMA DEATHSSINCE MIDNIGHT

  3. TIME OF ESSENCE • What are areas where time is wasted? • Trimodal death and the Golden Hour • 3 peaks of death • 1st peak-seconds to minutes after injury-due to brain lacerations,rupture aorta…. • 2nd peak minutes to hours after injury-the peak of avoidable death-the golden Hour • 3rd peak in ICU-due to sepsis, MOD….. • WHERE DO U PUT YOUR MONEY?

  4. Time of essence • Yes exactly • It is in the Golden Hour • So again where is waste of time usuallly occur? • 1.in the field: Scoop and run • – not stay and play • 2.in hospital: be prepared • mobilize Trauma Team

  5. prioritization • Triaging according to : • Salvagability: Donot waste time on unsalvagable cases • Severity of injury(ABCDE): Donot waste time on <life threatening injuries

  6. Spicy Pizza • Ensure your safety and yor team • Triage multiple casualities • Prioritize (ABCDE)&manage accordingly • Notify the hospital • Scoop and run

  7. Spicy pizza in hospital • Do Primary Survey-minutesonly • What is primary survey? ABCDE Talk to the victim:a verbal response means a patent airway and reasonable breathing. If no verbal reponse then The Pizza Indian spicy&v. hot

  8. ABCDE • Airway and C–spine immobilization • Breathing • Circulation • Disability • Exposure / Environment control

  9. ABCDE • Open the airway: chin lift& jaw thrust • No head tilt • No hyperextension • No hyperflexion • No rotation • But maintain on-line immobilization • May need adjuncts

  10. airway • Oro&nasopharyngeal airway • Suction • Removal of denture ,FB… • Ambu-bag • Endotracheal intubation, LMA • Cricothyrotomy • C-spine immobilization • In short: maintain the airway

  11. Breathing • 4 conditions need to be recognized-treated • Tension pneumothorax • Open pneumothrax • Flial chest • Massive hemothorax • The good news is--- • u need 2 tubes&1 needle and mask • Most life-threatening thoracic injuries can be treated by airway control, needle/chest tube insertion

  12. Thoracic injuries • Inspect---close an open pneumoth. • Palpate –flial chest: may need intubation? • Percuss& auscultate • needle for tension pneumoth ---tube for massive hemothorax +? • Blood & R/L solution. • Again u need 2 tubes,needle,and mask

  13. Circulation -SHOCK • Bleeding is the predominant cause of death. • Shock recognition: • pulse, skin color , level of conciousness. • Pulse : rate. Volume and regularity. • Bp -----late • Anatomical vs physiological derangement • These changes occur with bleeding anywhere—do I need to know the exact anatomical source? • Not really ….early management is the same.

  14. Hemorragic shock-management • Support circulation and stop bleeding. • Support circulation: 2 wide bore cannula • 2L warmed R/L , blood • Avoid hypothermia---risk of coagulopathy. • Stop bleeding: • stop external bleeding by direct pressure • How about torniquet ? • Only in bleeding amputated limb • Splint fracture e.g pelvic fracture

  15. TRANSIENT RESPONSE---WHY? • Ongoing bleed….or may be ..??? • Other causes of shock-- obstructive shock • Obstructive e.g tension pneumothorax & tamponade (treated by pericardiocentesis) • Keep an eye open to other possibilities? • Neurogenic shock: IVF + - vasopressors. • Periodic re-evaluation esp indeterioration

  16. D - Disability • GCS or AVPU • GCS 3-15: 3 worst, and 15 best • What can cause abnormal GCS? • Of course brain injury, but what else? • Hypotension and hypoxia. • Any deterioration of GCS is due to brain injury----check pulse-ox & vitals 1st . • Always assume spinal injury , so immobilize spines--- cervical collar & backboard.

  17. E ----Exposure & Environment control • Exposure is nessary for proper assessment, and to avoid missing injuries • Avoid unnecessary exposure • Warmed IVF • Warm blankets • Raise room temperature. • Any relation between E & C ?

  18. Adjuncts to primary survey • X-ray chest & pelvis - + C-spine • Pulse-ox • ECG monitoring • NGT. • Urinary catheter.

  19. END OF PRIMARY SURVEY • WHAT NOW? • Consider transfer( remember time) …next…? • Secondary survey: head- toe examination • Re-evaluate and re-evaluate… • Re-evaluate …. • Re-evaluate…

  20. summary • Time of essssssence • Triage according to salvagability • Prioritize according to ABCDE • Early Recognition,Early intervention,Early transfer-scoop and run

  21. Remember • Never forget your ABC…what is ABC? • Almond Board of California

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