29. Emergency Room Trauma

7/25/2019 29. Emergency Room Trauma

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TRAU M A IN TH EEM ERGEN CY RO O M

UNHAS SEKOLAH KEDOKTERANPRESENTED BY DR PHILIP STOKOE16 FEBRUARY 2011



THE CALGARY CAM BRIGE SCHEM E

Initiating the session

Gathering information

Physical examination Explanation and planning

Closing the session

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POM R - Problem oriented M edical Record

A% History• &all• Head in'(ry•

Headache• )i*c(lty in +al,ing• Semi-conscio(s

.% Past history Hypertension Treatment )ia/etes mellit(s )r(g addict Alcohol (se

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POM R - Problem oriented M edical Record -Cont’d

C% Exam)% )i1erential diagnosisE% Initial pro/lem related plans

• Imaging• .lood Exam• !onitoring Tests• Treatment

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HISTORY TAKING SE!ENCE

Presenting Symptoms 3PS4

History of Presenting Illness 3HPI4

Past History 3PH4 Social History 3SH4

&amily History 3&H4

System e5ie+ 3S4

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PROGRESS NOTES

S7 S(/'ecti5e #7 #/'ecti5e A7 Assessment P7 Plan


FLOW CHART

Dx : Diagno!i" T#! •B$oo% #xa&•I&aging

'x: 'oni!o(ing T#! •Con!in)o) B$oo% T#!•S#"on% I&aging•*$ago+ "a$#

Rx: T(#a!&#n! •I, -)i%•O2

E%: E%)"a!ion •Con)$!a!ion•Pa!i#n! A%.i"#•Fa&i$/ A%.i"#



"I##ERENTIAL "IAGNOSIS #ROM

SYM PTOM S$SIGNS

A% Ne(rological systems and mentalstate9% )o yo( get headache:

$% Is yo(r headache 5ery se5ere and did it/egin 5ery s(ddenly: S(/-arachnoidhaemorrhage

0% Ha5e yo( had memory pro/lems or tro(/leconcentrating

2% Ha5e yo( had fainting episodes; <ts or/lac,o(ts:

6% )o yo( ha5e tro(/le seeing or hearing:

8% Are yo( di==y:UNHAS – TAU!A IN E!EGENC" ##! >




SYM PTOM S$SIGNS % Cont’d

>% Ha5e yo( had +ea,ness; n(m/ness orcl(msiness in yo(r arms or legs:

?% Ha5e yo( e5er had a stro,e or head

in'(ry:@% Ha5e yo( had di*c(lty sleeping:

9%)o yo( feel sad or depressed; or ha5epro/lems +ith yo(r Bner5es:

99%Ha5e yo( e5er /een sex(ally or physicallya/(sed:

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.% Epilepsy• Genetic• Head tra(ma• Intra cranial t(mo(rs• Stro,es• A/cess• Alcohol• )r(gs• Uraemia

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C% Unconscio(sness• .oggy scalp s+elling• )epression crani(m• Alcohol /reath• Needle mar,s• Hepatomegaly• HypertensionDhypotension• )ia/etic coma – s+eet /reath




GRA"ING O# COM A

9% Alert

$% )ro+sy /(t responds to 5er/al stim(lation

0% Unconscio(s – no response to 5er/al

stim(lation; /(t +ithdra+al response to pain

2% Unconscio(s – decorticate responses to pain3exion of (pper lim/ and extension of lo+erlim/4

6% Unconscio(s – decere/rate responses to pain3hyperextension of /oth (pper and lo+erlim/s4

8% Unconscio(s p no response to pain




GLASGO& COM A SCALEPa!i#n!

(#on#

S"o(# 0300 1030

0

1230

0

E/# o#ning Son!an#o) 4

To ##"5

To ain 2

Non# 1

B#! .#(7a$(#on#

O(i#n!#% 8

Con9)#% 4

Ina(o(ia!#

In"o&(#5#ni7$# 2

Non# 1

B#! &o!o((#on#

O7#/ing 6

Lo"a$iing 8UNHAS – TAU!A IN E!EGENC" ##! 9$



SYM PTOM S$SIGNS O# COM A

Ta,e history if possi/le

Assess le5el of conscio(sness – (se Glasgo+coma scale /(t remem/er its limitations

Foo, for sings of meningeal irritation Assess p(pils

Assess oc(lar mo5ements; if necessary (singdolls head manoe(5re

Assess motor responses Assess respiration

Perform a general physical examination;incl(ding the heart; a/domen and s,(ll




CRITERIA #OR BRAIN "EATH

)ilated p(pils

No corneal response

esti/(lar oc(lar reex !otor response to painf(l stim(l(s to

gla/ella

No gag response to trachealresponse

Steroterio(s /reathing




THE !NCONSCIO!S PATIENT

C –C#$ narcosis 3respiratory fail(re7(ncommon4

O – #5erdose7 for example; trang(illisers;

alcohol; salicylates; car/on monoxide;antidepressants

'- !eta/olic7 for example; hypoglycaemia;dia/etic ,etoacidosis; (raemia;

hypothyroidism; hepatic coma;hypercalcaemia; adrenal fail(re

A- Apoplexy7 for example; head in'(ry;cere/ro5asc(lar accident 3infarction or

haemorrhage4; s(/d(ral or extrad(ralUNHAS – TAU!A IN E!EGENC" ##! 96



GENERAL INSPECTION O# TRA!M A PATIENT

emem/er A-.-C7

Air+ay;

.reathing and

Circ(lation




GENERAL INSPECTION O# TRA!M A PATIENT-

Cont’d

Air+ay and .reathing7

Foo, to see if the patient is /reathing; as indicated/y chest +all mo5ement% If not; (rgent attention is

re(ired; incl(ding clearing the air+ay andpro5iding 5entilation% Note partic(larly the patternof /reathing% Cheyne Sto,es respiration 3+hichmay indicate diencephalic in'(ry; /(t is notspeci<c4; irreg(lar ataxic /reathing 3.iots

/reathing; from an ad5anced /rainstem lesion4;and deep rapid respiration 3e%g% (ssma(l/reathing; secondary to a meta/olic acidosis; as india/etes mellit(s4 are important signs to loo, for%

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GENERAL INSPECTION O# TRA!M A PATIENT-

Cont’d

Circ(lation 7

Foo, for signs of shoc,; dehydration

and cyanosis% A typical cherry-redcolo(r occ(rs rarely in cases of car/onmonoxide poisoning% Ta,e the p(lserate and /lood press(re%

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29. Emergency Room Trauma

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