3. •Globally, about 16,000 people die of
injures ever day and about 5.8 million
people die every year.
•WHO data shows that 1 in 10 deaths
worldwide is the result of an injury.
5. 1st peak: Severe brain lacerations
Brain stem injuries
High spinal cord injuries
Heart & Aorta injuries
2nd peak: Airway obstruction
Hemopneumothorax
Internal Hge.
Epidural or subdural Hge.
3rd peak: Sepsis
Organ failure
Pulmonary embolism
6. TRAUMA SYSTEM
Trauma system approach is the integration
of all aspects of trauma care to achieve the
best outcome
Components of the trauma system
a) Pre-hospital care
b) In-hospital care
c) Rehabilitation
d) Prevention
e) Education
f) Research.
7. Pre-hospital care
Airway
Breathing
Circulation
Keeping the patient immobilised.
Keeping time at the scene to a minimum.
Co-ordination and communication with the
receiving hospital
8. Trauma triage
Trauma triage is the use of trauma assessment for
prioritising of patients for treatment or transport
according to their severity of injury , given the
limitations of the current situation, the mission, and
available resources
Triage occurs at every level of care, starting with medic
care, extending through the OR, the ICU, and the
evacuation system.
Triage Categories:
Immediate: Treatable life threatening injury.
Delayed: Serious but not life threatening injuries.
Minimal: Walking, wounded.
Expectant: Dead or fatally injured.
9. Minimise mortality &
morbidity by
• Critical decision-making and planning
• Cellular protection
• Liberal communication
• Definitive surgical procedures
• ICU/HDU level care in major trauma
• Appropriate medical support
• Rehab assessment and planning
13. Breathing
Assessment: Look
Listen
Feel
Management:
100% O2
Assisted ventilation by Ambu bag
Urgent needle decompression for
tension pneumothorax
Intercostal tube + under water seal for
hemo- pneumothorax
14. Circulation
Assessment:
• Vital data
• UOP
• Class of shock
Management:
•2 I.V. Wide bore cannulae
•Give 2 litres of crystalloids
(preferably Ringer’s Lactate)
•Stop external bleeding
•Pericardiocentesis if there is cardiac
tamponade
16. Exposure
Undress the patient, but prevent
hypothermia.
Clothes may need to be cut off but.
After examination, attention to prevention of
heat loss with warming devices, warmed
blankets.
17. Adjuncts to 1ry survey
Monitoring
Urinary catheter and NGT
X-ray cervical spine, chest and pelvis
19. Exposure
Baseline Monitoring
Venous Cut Down
Blood Transfusion
Reassess Oxygenation
Hge. Control
Splinting of The Fractures
Dressing of The Wounds
Drugs: Analgesics, Antibiotics,antitetanic
Serum and Corticosteroids.
21. Continue monitoring
Examination of the body by region
Complete neurological examination
including GCS
History taking:
A = Allergies
M = Medication currently used
P = Past illnesses/Pregnancy
L = Last meal
E = Events/Environment related to injury
Basic X-rays
23. Goals of Definitive Care
1. Prevent early death
2. Minimise morbidity
• sepsis
• multi-organ failure
• disability
• length of stay
3. Maximise function
24. •Thoracic injuries (specially penetraring
wounds of the heart, tension and open
pneumothorax, hemothorax and flail chest)
•Abdominal injuries (specially involving
Aorta and IVC)
•Cerebral injuries (N.B. Skull # not associated
with IC Hge. are dealt with after more critical
thoracic and abdomenal injuries)
•Urological injuries
•Long bone fractures
•Contaminated wounds
26. Early Cellular Protection
• Airway maintenance
• Optimise oxygenation/ventilation
• Stop the bleeding
• Support circulation
• Prevent raised ICP
• Control contamination/sepsis (<3
hours)
• Debridement (<6 hours)
• Fracture stabilization
27. Hypotensive resuscitation:
Keep systolic pressure at 85 – 90.
This is sufficient for vital organ perfusion
Prevent BP overshoot and risk of increased Hge.
FUST / FAST:
Focused Abdominal Sonogram for Trauma
Assess: liver, spleen, pelvic or abdomenal free
collection, pleural effusion or hemopericardial
Advantages
Disadvantages
29. Pregnant trauma patient
Maternal resuscitation and survival is key to fetal survival.
The fetus may be in distress despite a well appearing mother.
History: Mechanism
Last menstrual period (LMP)
Uterine contractions
Fetal movement
Premature rupture of membranes
Vaginal bleeding
SBP decrease by 2-4 mm Hg, DBP decreases by 5-15 mm Hg
in mid-trimester. Heart rate increases by 10-15 B/M.
Obstetric assessment
30. Work up
Lap. Work: Plasma volume increases by 50%, average
hematocrit level is 32-34% , Pregnancy-induced
leukocytosis , electrolyte and glucose.
Imaging Studies: Usually, adverse effects are not
expected until the dose is 5-10 rad. Shielding the patient
with lead decreased the radiation exposure by 50 to 75%.
2 view chest 0.00007 rads, CT scan head <0.05 rads,
chest CT<0.1 rads
Others: CTG
31. Management
Position: The patient should be tilted 15° to the
left.
Airway and breathing: All pregnant trauma
patients should receive supplemental oxygen
because the fetus is extremely sensitive to
hypoxia. If a chest tube is placed, enter the chest 1
or 2 interspaces higher than usual.
Circulation: the relative hypervolemia of
pregnancy allows for a 30-35% loss of blood
volume before hypotension develops.
32. Trauma in the elderly
The aging process and the presence of chronic
diseases results in decreased functional reserve
which may produce a diminished physiologic
response to adjust to traumatic injuries.
33. Airway: increased risk of aspiration
Dentures
Intubation may be difficult due to temporomandibular
arthritis.
Cervical spine disease results in more difficulty with
airway management.
Breathing: There is a reduction of the efficiency of
ventilation with age.
Circulation : The normal tachycardic and
vasoconstrictor response to hypovolaemia may be
blunted.
Disability: In case of decline in intellectual or cognitive
function, decreased sensory input, and altered
mentation by medication the neurological assessment
may be difficult.
34. Paediatric Trauma
Smaller body size in children often makes them
more prone to poly traumatic injury.
A child's weight to surface area ratio is lower than
an adult's and thus have a higher risk of
becoming hypothermic.
Infants and children are at special risk of
becoming dehydrated and hypoglycemic
Among children, the CNS is the most commonly
injured isolated system.
Shaken baby syndrome
35. Management
Airway: A child has a shorter neck, smaller and anterior
larynx, floppy epiglottis, short trachea, and large tongue.
Breathing: children are primarily diaphragmatic breathers;
hence any compromise of diaphragmatic movement
significantly limits the child's ability to ventilate.
Circulation: Obvious signs of shock, such as hypotension
or a decrease in urinary output, may not occur until more
than 30% of blood volume has been lost. Initial fluid
resuscitation should consist of a bolus of 20 mL/kg.
Children with evidence of hemorrhagic shock who fail to
response to fluid resuscitation should also receive blood
(10 mL/kg) and be evaluated by a pediatric surgeon for
possible operative intervention.