Lecture1 2 Advancedemergencytraumacourse Introductionandcourseoverview 1

8/9/2019 Lecture1 2 Advancedemergencytraumacourse Introductionandcourseoverview 1

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Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, CarlSeger, 2009-2010.

License: Unless otherwise note, this !aterial is !ae a"aila#le$ner the ter!s of the Creative Commons Attribution 3.0License%htt&%''creati"eco!!ons.org'licenses'#(').0'We have reviewed this material in accorance with U.S. Co&(right *aw and have tried tomaximize your ability to use share and ada!t it. +he citation ke( on the following slie&ro"ies infor!ation a#o$t how (o$ !a( share an aa&t this !aterial.

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se *hare Ada!t

+a,e -our wn Assessment

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O$r eter!ination 7* 8 !ean that all $ses of this )r-&art( content are air Uses an we 8

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; Content O&en.=ichigan #elie"es can #e $se, share, an aa&te #eca$se it is ineligi#le for co&(righ

; Content O&en.=ichigan has $se $ner a air Use eter!ination.


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Advanced Emergency

Trauma Course

8hana >!ergenc( =eicine

@ntro$ction an Co$rse O"er"iew

@nitial /ssess!ent an=anage!ent

Presenter% Patrick Carter, =D


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Objectives @ntro$ction to />+C Co$rse

Co$rse C$rric$l$! >&ie!iolog( of +ra$!a Care Aistor( of De"elo&!ent of +ra$!a Care =echanis!s of @n5$r( Basics of +ra$!a =anage!ent

Pri!ar( S$r"e(

Res$scitation

Seconar( S$r"e( /BCD> or!at

Cer"ical S&inal @!!o#iliation S&ecic Case >7a!&les

1hana 7mer"ency +edicineCollaborative


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AETC Course /"ance >!ergenc( +ra$!a Co$rse De"elo&e #( Uni"ersit( of =ichigan an

Uni"ersit( of Utah >!ergenc( =eicine ac$lt( 8eneral O"er"iew of +ra$!a =anage!ent

U.S. #ase >= C$rric$l$! /+*S C$rric$l$!

a( co$rse

20 ho$rs of iactic teaching Skill Stations for "ital tra$!a &roce$res

Re"iew an testing on a(



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AETC Course

>"al$ation +ools Pre'Post +est of +ra$!a Enowlege Pre'Post Skill Station >"al$ations

Post Co$rse S$r"e(

F =onth Post Co$rse S$r"e(

Research St$( Gol$ntar( @n"ol"e!ent

Co$rse $tilies new teaching techni$es O&en e$cational Reso$rce =aterial *ow +echnological Si!$lation +ools



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AETC Course Schedule



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AETC Skill Stations



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Initial Assessment and

Management of the Trauma

Patient

Ghana Emergency MedicineGhana Emergency MedicineCollaborativeCollaborative

Advanced Emergency Trauma CourseAdvanced Emergency Trauma Course

So$rce% www.aic.c$hk.e$.hk'we#Htoc.ht!/ccesse 9'20'09 I Jahoo i!ages "ia Creati"eCo!!ons

http://www.aic.cuhk.edu.hk/web8toc.htmhttp://rds.yahoo.com/_ylt=A0WTefM8QLZKhVIA73ejzbkF/SIG=146jm914t/EXP=1253544380/**http:/www.aic.cuhk.edu.hk/web8/Hi%20res/trauma%20patient%20-%20intubated%20with%20chest%20drain.jpghttp://www.aic.cuhk.edu.hk/web8toc.htm


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Eidemiology

Roa +raKc /ccients are !a5or ca$se of long ter!!or#iit( an !ortalit( in e"elo&ing nations

@n the rst $arter of 2009, )2 eaths in 8hana fro!Roa +raKc /ccients

2L increase fro! &re"io$s (ear

WAO &reicts that #( 2020, Roa +raKc /ccients will #esecon leaing ca$se of loss of life for worlMs &o&$lation Aigh =or#iit( N *oss of inco!e to societ( Challenges in De"elo&ing Co$ntries

+echnological /"ances in +ra$!a Care

*ack of @nfrastr$ct$re for +ra$!a =anage!ent >=S Pre-hos&ital notication =D'R +raining in tra$!a care



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Eidemiology

@!!eiatel( Ao$rs Da(s'Weeks

0L

)0L

20L

+ri!oal Distri#$tion of +ra$!a Deaths

8olen Ao$r N H0L of tra$!aeaths in rst ho$r after in5$r(

Ra&i tra$!a care has greatestle"el of i!&act in these &atients



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!istory of Trauma System "eveloment Stanarie +ra$!a /ssess!ent

e#raska Cornel, 19F Ortho&eic S$rgeon *ea to e"elo&!ent of /+*S

+ra$!a S(ste!s De"elo&!ent irst e"elo&e !( !ilitar( in warti!e

i.e. =/SA Units

>7&ane in US to *e"el 1, 2, ) +ra$!aCenters Ur#an S(ste!s Statewie networks of s(ste!s Level 9 I Aighest le"el of care, *eaers in

research, clinical care an e$cation

Level I Pro"ies eniti"e care in wie range ofco!&le7 tra$!atic &atients

Level 3 I Pro"ies initial sta#iliation antreat!ent. =a( care for $nco!&licate tra$!a&atients

Level ; I Pro"ies initial sta#iliation antransfers all tra$!a &atients for eniti"e care


Otisarchi"es1 ickr3

http://www.flickr.com/photos/medicalmuseum/249929233/http://www.flickr.com/photos/medicalmuseum/249929233/


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Mechanisms of Injury Bl$nt +ra$!a

Co!&ression orces Cells in tiss$es are co!&resse an cr$she >.g. S&leen

Shear orces

/cceleration'Deceleration @n5$r( >.g. /orta

Shearing force N S&ectr$! fro! $ll thickness tear>7sang$ination3 to Partial tear Pse$oane$r(s!3

O"er&ress$re Bo( ca"it( co!&resse at a rate faster than the

tiss$e aro$n it, res$lting in r$&t$re of the closes&ace

>.g. Plastic #ag >.g. in tra$!a N ia&hrag!atic r$&t$re, #laer

in5$r(



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Mechanisms of Injury rontal @!&act Collisions

*ateral @!&act Collisions + #one3 Rear @!&act Collisions

Rollo"er =echanis! O&en Gehicle or =otorc(cle'=o&e

Peestrian Gs. Car

Penetrating @n5$r( 8$ns "s. Eni"es3


Gincent Q Brown ickr3

Enockhill ickr3

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ico.se ickr3

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#asics of Trauma Assessment Pre&aration

+ea! /sse!#l(

>$i&!ent Check +riage

Sort &atients #( le"el of ac$it( S/+S3

Pri!ar( S$r"e(

Designe to ientif( in5$ries that are i!!eiatel( life threatening an

to treat the! as the( are ientie Res$scitation

Ra&i &roce$res an treat!ent to treat in5$ries fo$n in &ri!ar(s$r"e( #efore co!&leting the seconar( s$r"e(

Seconar( S$r"e(

$ll Aistor( an Ph(sical >7a! to e"al$ate for other tra$!atic in5$ries =onitoring an >"al$ation, Seconar( a5$ncts +ransfer to Deniti"e Care

@CU, War, O&erating +heatre, /nother facilit(



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Prearation $ $ $ Coming Attractions

Organie +ra$!aRes&onse +ea!


htt&%''www.tra$!a.org'archi"e'res$s'tra$!atea!.ht!l


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Primary Survey

Airwa( an Protection of S&inal Corn"iron!ent



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Primary Survey

Ee( Princi&les When (o$ n a &ro#le! $ring the

&ri!ar( s$r"e(, 26= 68.

@f the &atient gets worse, restart fro!the #eginning of the &ri!ar( s$r"e(

So!e critical &atients in the>!ergenc( De&art!ent !a( not

&rogress #e(on the &ri!ar( s$r"e(



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Air%ay and Protection of Sinal Cord

Wh( rst in the algorith!

*oss of airwa( can res$lt in eath in ) !in$tes Prolonge h(&o7ia N @nae$ate &erf$sion, >n-organ

a!age /irwa( /ssess!ent

Gital Signs N RR, O2 sat

=ental Stat$s N /gitation, So!nolent, Co!a /irwa( Patenc( N Secretions, Strior, O#str$ction +ra$!atic @n5$r( a#o"e the cla"icles Gentilation Stat$s N /ccessor( !$scle $se, Retractions,

Wheeing Clinical Pearls

Patients who are s&eaking nor!all( generall( o notha"e a nee for i!!eiate airwa( !anage!ent

Aoarse or weak "oice !a( inicate a s$#tle tracheal orlar(ngeal in5$r(

ois( Res&irations fre$entl( inicates an o#str$cte

res&irator( &attern1hana 7mer"ency +edicineCollaborative


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Air%ay Interventions

=aintenance of /irwa( Patenc( S$ction of Secretions Chin *ift'Qaw thr$st aso&har(ngeal /irwa( Deniti"e /irwa(

/irwa( S$&&ort O7(gen RB= 100L3 Bag Gal"e =ask Deniti"e /irwa(

Deniti"e /irwa( >notracheal @nt$#ation

@n-line cer"ical sta#iliation

S$rgical Crichoth(roioto!(


Source undetermined

Source undetermined

Source undetermined


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Protection of Sinal Cord 1eneral 5rinci!le: Protect the entire s&inal cor $ntil

in5$r( has #een e7cl$e #( raiogra&h( or clinical

&h(sical e7a! in &atients with &otential s&inal cor in5$r(. S&inal Protection

Rigi Cer"ical S&inal Collar N Cer"ical S&ine *ong rigi s&inal #oar or i!!o#iliation on at s$rface s$ch

as stretcher N +'* S&ine

>tiolog( of S&inal Cor @n5$r( U.S.3 Roa +raKc /ccients TL3 Aigh energ( falls 2)L3

Clinical Pearls +reat!ent @!!o#iliation3 #efore iagnosis

Ret$rn hea to ne$tral &osition Do not a&&l( traction Diagnosis of s&inal cor in5$r( sho$l not &recee

res$scitation =otor "ehicle crashes an falls are !ost co!!onl(

associate with s&inal cor in5$ries

=ain foc$s N Pre"ention of f$rther in5$r(1hana 7mer"ency +edicineCollaborative


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C&sine Immobili'ation

Ret$rn hea to ne$tral &osition =aintain in-line sta#iliation Correct sie collar a&&lication Blocks'ta&e San#ags


*ource:www.ossur.com>bracesandsu!!orts>nec, ands!ine>!rehos!it...oncollars>!hillybloc,headAccessed ?>0>0?

-ahoo 6ma"es

Palainsf ickr3

http://www.flickr.com/photos/paladinsf/3408597000/in/photostream/http://rds.yahoo.com/_ylt=A0WTb_q0TbZKqSEBYSWjzbkF/SIG=12b6bq26g/EXP=1253547828/**http:/www.ossur.com/lisalib/getfile.aspx?itemid=5748http://www.flickr.com/photos/paladinsf/3408597000/in/photostream/


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Breathing and (entilation

8eneral Princi&le% /e$ate gas e7change is re$ire to!a7i!ie &atient o7(genation an car#on io7ieeli!ination

Breathing'Gentilation /ssess!ent% >7&os$re of chest 8eneral @ns&ection

+racheal De"iation /ccessor( =$scle Use Retractions /#sence of s&ontaneo$s #reathing Parao7ical chest wall !o"e!ent

/$sc$ltation to assess for gas e7change

>$al Bilaterall( Di!inishe or /#sent #reath so$ns

Pal&ation De"iate +rachea Broken ri#s @n5$ries to chest wall



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@entif( *ife +hreatening @n5$ries

+ension Pne$!othora7 /ir tra&&ing in the &le$ral s&ace #etween

the l$ng an chest wall S$Kcient &ress$re #$ils $& an

&ress$re to co!&ress the l$ngs an shift

the !eiastin$! Ph(sical e7a! /#sent #reath so$ns

/ir h$nger

Distene neck "eins

+racheal shift

+reat!ent eele Deco!&ression

2n @ntercostal s&ace, =icla"ic$lar line

+$#e +horacosto!( th @ntercostal s&ace, /nterior a7illar(

line

Breathing and Ventilation


*ource: www.meddean.luc.edulumen+ed7d>medicine>!ulmona

r>cxr>!neumo9.htmAccessed ?>0>0? / -ahoo6ma"es

elldot (wi,imedia)

http://rds.yahoo.com/_ylt=A0WTefTNU7ZKfNkATBujzbkF/SIG=135cptqle/EXP=1253549389/**http:/www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/atlas/images/81l.JPGhttp://rds.yahoo.com/_ylt=A0WTefTNU7ZKfNkATBujzbkF/SIG=135cptqle/EXP=1253549389/**http:/www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/atlas/images/81l.JPGhttp://rds.yahoo.com/_ylt=A0WTefTNU7ZKfNkATBujzbkF/SIG=135cptqle/EXP=1253549389/**http:/www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/atlas/images/81l.JPGhttp://commons.wikimedia.org/wiki/File:Sucking_chest_wound_mechanics.jpg


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Ae!othora7

Bloo collecting in the &le$ral s&acean is co!!on after &enetrating an#l$nt chest tra$!a

So$rce of #leeing N *$ng, Chest wall

intercostal arteries3, heart, great"essels /orta3, Dia&hrag!

Ph(sical >7a! /#sent or i!inishe #reath so$ns D$llness to &erc$ssion o"er chest

Ae!o(na!ic insta#ilit(

+reat!ent N *arge Cali#er +$#e +horacosto!(

10-20L of cases will re$ire +horacoto!( for control of#leeing



htt&%''www.tra$!a.org'ine7.&h&'!ain'i!ages'C11'/ccesse 9'20'09 I Jahoo @!ages

http://www.trauma.org/index.php/main/images/C11/http://www.trauma.org/index.php/main/images/C11/http://www.trauma.org/index.php/main/image/119/C11http://www.trauma.org/index.php/main/images/C11/http://www.trauma.org/index.php/main/images/C11/


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lail Chest Direct in5$r( to the chest res$lting in an$nsta#le seg!ent of the chest wall that!o"es se&aratel( fro! re!ainer ofthoracic cage

+(&icall( res$lts fro! two or !ore

fract$res on 2 or !ore ri#s +(&icall( /cco!&anie #( a &$l!onar(cont$sion

Ph(sical >7a! N Parao7ical !o"e!entof chest seg!ent

+reat!ent N @!&ro"e /#nor!alities in

gas e7change >arl( @nt$#ation for &atients with

res&irator( istress /"oiance of o"eraggressi"e $i

res$scitation


htt&%''i!ages1.clinicaltools.co!'i!ages'tra$!a'ailchestwo$ne.gif

htt&%''www.s$rgical-t$tor.org.$k'efa$lt-

ho!e.ht!s&ecialities'cariothoracic'chesttra$!a.ht!Vright

I


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O&en Pne$!othora7 S$cking Chest Wo$n *arge efect of chest wall

*eas to ra&i e$ili#ration ofat!os&heric an intrathoracic

&ress$re @!&airs o7(genation an

"entilation

@nitial +reat!ent +hree Sie occl$si"e ressing

Pro"ies a $tter "al"e e6ect Chest t$#e &lace!ent re!ote to

site of wo$n /"oi co!&lete ressing, will

create a tension &ne$!othora7


=ile an #otto! i!age%

htt&%''www.#rooksie&ress.org'Pro$cts'O&erational=eicine'D/+/'o&erational!e'Proce$res' +reataS$ckingChestWo$n.ht!/ccesse 9'20'09 I Jahoo @!ages

htt&%''www.tra$!a.org'ine7.&h&'!ain'i!age'902'/ccesse 9'20'09, Jahoo @!ages

http://www.trauma.org/index.php/main/image/902/http://www.trauma.org/index.php/main/image/902/http://www.trauma.org/index.php/main/image/902/


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)eedle Thoracostomy

eele +horacosto!(

=icla"ic$lar line 1T g$age angiocath

O"er the 2n ri#

R$sh of air is hear


www.tra$!a.org'ine7.&h&'!ain'article'19

9'ine7.&h&!ain'i!age'9'/ccesse 9'20'09 I Jahoo @!ages

http://rds.yahoo.com/_ylt=A0WTb_zZWrZKiiUACgOjzbkF/SIG=125295vh2/EXP=1253551193/**http:/www.trauma.org/images/articles/ndecomp.jpg


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Tube Thoracostomy @nsertion site

th intercostal s&ace,

/nterior a7illar( line Sterile &re&, anesthesia with liocaine 2-) c! incision along ri# !argin with 10

#lae Dissect thro$gh s$#c$taneo$s tiss$es to

ri# !argin P$nct$re the &le$ra o"er the ri# /"ance chest t$#e with cla!& an irect

&osteriorl( an a&icall( O#ser"e for fogging of chest t$#e, #loo

o$t&$t S$t$re the t$#e in &lace Co!&lications of Chest +$#e Place!ent

@n5$r( to intercostal ner"e, arter(, "ein @n5$r( to l$ng @n5$r( to !eiastin$! @nfection /llergic reaction to liocaine

@na&&ro&riate Place!ent of chest t$#e1hana 7mer"ency +edicineCollaborative

www.si!$la#.co!'+ra$!a=an...tesis.ht!'/ccesse 9'20'09 I Jahoo@!ages

htt&%''www.tra$!a.org'i!ages'

i!ageli#rar('chest001a.5&g/ccesse 9'20'09 IJahoo@!ages

http://www.simulab.com/TraumaMan...tesis.htm/http://www.simulab.com/TraumaMan...tesis.htm/http://www.trauma.org/images/image_library/chest0051a.jpghttp://www.trauma.org/images/image_library/chest0051a.jpghttp://rds.yahoo.com/_ylt=A0WTbx7vXLZKT7cA6YGJzbkF;_ylu=X3oDMTByMjRlMnFzBHBvcwMxNwRzZWMDc3IEdnRpZANJMTE2XzEzNw--/SIG=1jns74smc/EXP=1253551727/**http:/images.search.yahoo.com/images/view?back=http://images.search.yahoo.com/search/images?p=Chest+tube&cc=1&b=1&ni=18&ei=UTF-8&pstart=1&fr2=tab-web&w=640&h=480&imgurl=www.simulab.com/images/ChestTube2.jpg&rurl=http://www.simulab.com/TraumaMan%20Chest%20Tube%20Insertion%20&%20Pericardiocentesis.htm&size=52k&name=ChestTube2+jpg&p=Chest+tube&oid=c6ce4474017a0d84&fr2=tab-web&no=17&tt=2790&b=1&ni=18&sigr=12ovus1s0&sigi=115cdceiu&sigb=13642r1othttp://www.trauma.org/images/image_library/chest0051a.jpghttp://www.trauma.org/images/image_library/chest0051a.jpghttp://www.simulab.com/TraumaMan...tesis.htm/http://www.simulab.com/TraumaMan...tesis.htm/


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Circulation Shock

@!&aire tiss$e &erf$sion +iss$e o7(genation is inae$ate to !eet !eta#olic e!an Prolonge shock state leas to !$ltiorgan s(ste! fail$re an

cell eath Clinical Signs of Shock

/ltere !ental stat$s

+ach(caria AR X 1003 N =ost co!!on sign /rterial A(&otension SBP 1203 e!oral P$lse I SBP X H0 Raial P$lse I SBP X 90 Caroti P$lse I SBP X F0

@nae$ate +iss$e Perf$sion

Pale skin color Cool cla!!( skin Dela(e ca& rell X ) secons3 /ltere *OC Decrease Urine O$t&$t UOP 0. !*'kg'hr3



31/66

Circulation

+(&es of Shock in +ra$!a Ae!orrhagic

/ss$!e he!orrhagic shock in all tra$!a &atients$ntil &ro"en otherwise

Res$lts fro! @nternal or >7ternal Bleeing

O#str$cti"e Cariac +a!&onae +ension Pne$!othora7

e$rogenic S&inal Cor in5$r(

So$rces of Bleeing

Chest /#o!en Pel"is Bilateral e!$r ract$res



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Circulation >!ergenc( $rsing +reat!ent

+wo *arge @G *ines Cariac =onitor Bloo Press$re =onitoring

8eneral +reat!ent Princi&les Sto& the #leeing

/&&l( irect &ress$re

+e!&oraril( close scal& lacerations Close o&en-#ook &el"ic fract$res

/#o!inal &el"ic #iner'#esheet

Restore circ$lating "ol$!e Cr(stalloi Res$scitation 2*3 /!inister Bloo Pro$cts

@!!o#ilie fract$res Res&oners "s. onres&oners

+ransient Res&onse to "ol$!e res$scitation N sign of ongoing#loo loss

onres&oners N Consier other so$rce for shock state oro&erating roo! for control of !assi"e he!orrhage



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Circulation

Pericarial +a!&onae Pericari$! or sac aro$n heart llswith #loo $e to &enetrating or#l$nt in5$r( to chest

BeckMs +ria Distene 5$g$lar "eins A(&otension =$Ye Aeart So$ns

+reat!ent

Ra&i e"ac$ation of &ericarial s&ace Perfor!e thro$gh a Pericariocentesis

te!&oriing !eas$re3 O&en +horacoto!(


A e a r t

Bloo

Pericari$!

>&icari$!

/ceofhearts19FH Wiki!eia3

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34/66

Pericardiocentesis

P$nct$re the skin 1-2 c! inferior to7i&hoi &rocess

T'T'T egree angle /"ance neele to ti& of left sca&$la Withraw on neele $ring a"ance of

neele Prefera#le $ner $ltraso$n g$iance or

>E8 lea G attach!ent Co!&lications

/s&iration of "entric$lar #loo *aceration of coronar( arteries, "eins,

e&icari$!'!(ocari$! Cariac arrh(th!ia Pne$!othora7 P$nct$re of eso&hag$s P$nct$re of &eritone$!


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www.#rooksie&ress.org'Pro$cts+ra$!aS$rger(=N//ccesse 9'20'09 I Jahoo @!ages

http://www.trauma.org/images/image_library/chest0054_thumb.jpghttp://www.trauma.org/images/image_library/chest0054_thumb.jpghttp://www.brooksidepress.org/ProductsTrauma_Surgery?M=Ahttp://www.brooksidepress.org/ProductsTrauma_Surgery?M=Ahttp://rds.yahoo.com/_ylt=A0WTbx6yY7ZK9swAUIOjzbkF/SIG=130tq8bb1/EXP=1253553458/**http:/www.brooksidepress.org/Products/Trauma_Surgery/Pericardiocentesis.jpghttp://rds.yahoo.com/_ylt=A0WTbx4eY7ZKzscA_iCjzbkF/SIG=12ioihojh/EXP=1253553310/**http:/www.trauma.org/images/image_library/chest0054_thumb.jpghttp://www.brooksidepress.org/ProductsTrauma_Surgery?M=Ahttp://www.brooksidepress.org/ProductsTrauma_Surgery?M=Ahttp://www.trauma.org/images/image_library/chest0054_thumb.jpghttp://www.trauma.org/images/image_library/chest0054_thumb.jpg


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Circulation

/ wor a#o$t cariac arrest . . . Care of the tra$!a &atient in cariac

arrest CPR Bilateral +$#e +horacosto!( Pericariocentesis Gol$!e Res$scitation

+ra$!atic Cariac /rrest $e to#l$nt in5$r( has "er( low s$r"i"alrate 1L3 o &oint for e!ergenc( thoracoto!(

Selecte cases of cariac arrest $eto &enetrating tra$!atic in5$r( !a(#enet fro! e!ergent thoracoto!( Pericarial ta!&onae Cross cla!& /orta


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36/66

Disability

Baseline e$rologic >7a! P$&illar( >7a! Dilate &$&il I s$ggests transtentorial herniation on i&silateral

sie

/GPU Scale /lert

Res&ons to "er#al sti!$lation Res&ons to &ain Unres&onsi"e

8ross e$rological >7a! I >7tre!it( =o"e!ent >$al an s(!!etric or!al gross sensation

8lasgow Co!a Scale% )-1 Rectal >7a!

or!al Rectal +one ote% @f int$#ation &rior to ne$ro assess!ent, consier

$ick ne$ro assess!ent to eter!ine egree of in5$r(



37/66

Disability 8lasgow Co!a Scale

>(e S&ontaneo$sl( o&ens T

+o "er#al co!!an )

+o &ain 2 o res&onse 1

Best =otor Res&onse

O#e(s "er#al co!!ans F *ocalies to &ain

Withraws fro! &ain T le7ion to &ain Decorticate Post$ring3 ) >7tension to &ain Decere#rate Post$ring3 2

o res&onse 1

Ger#al Res&onse Oriente'Con"ersant Disoriente'Conf$se T

@na&&ro&riate wors ) @nco!&rehensi#le wors 2

o res&onse 1

GCS ≤ 8

Intubate



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Disability

Ee( Princi&les Precise iagnosis is not necessar( at this&oint in e"al$ation

Pre"ention of f$rther in5$r( anientication of ne$rologic in5$r( is the goal

Decrease le"el of conscio$sness N Aeain5$r( $ntil &ro"en otherwise

=aintenance of ae$ate cere#ral &erf$sionis ke( to &re"ention of f$rther #rain in5$r(

/e$ate o7(genation /"oi h(&otension

@n"ol"e ne$ros$rgeon earl( for clearintracranial lesions



39/66

Disability

Cer"ical S&inal Clearance Patients !$st #e alert an oriente to

&erson, &lace an ti!e

ot clinicall( into7icate with alcohol orr$gs

on-tener at all s&ino$s &rocesses

o focal ne$rological ecits o istracting in5$ries

Painless range of !otion of neck



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E*osure Re!o"e all clothing

>7a!ine for other signs of in5$r(

@n5$ries cannot #e iagnose $ntil seen #( &ro"ier

*ogroll the &atient to e7a!ine &atientMs #ack

=aintain cer"ical s&inal i!!o#iliation Pal&ate along thoracic an l$!#ar s&ine

=ini!$! of ) &eo&le, often !ore &ro"iers re$ire

/"oi h(&other!ia

/&&l( war! #lankets after re!o"ing clothes A(&other!ia N Coag$lo&ath(

@ncreases risk of he!orrhage



41/66

E*osure


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E*osure


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;b.!"Accessed ?>0>0? I Jahoo @!ages


43/66

Trauma +ogroll One &erson N Cer"ical S&ine +wo &eo&le N Roll !ain #o( One &erson N @ns&ect #ack an

&al&ate s&ine


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Accessed 0,12,20 3 4ahoo Images


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Secondary Survey

Seconar( S$r"e( is co!&lete after&ri!ar( s$r"e( is co!&lete an&atient has #een ae$atel(

res$scitate. o &atient with a#nor!al "ital signs

sho$l &rocee thro$gh a seconar(

s$r"e( Seconar( S$r"e( incl$es a #rief

histor( an co!&lete &h(sical e7a!



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!istory

/=P*> Aistor(Allergies+eications

5ast =eical Aistor(, Pregnanc(Last =eal7"ents s$rro$ning in5$r(, >n"iron!ent

Aistor( !a( nee to #e gathere fro!fa!il( !e!#ers or a!#$lance ser"ice



46/66

Physical E*am

Aea'A>>+ eck Chest

/#o!en Pel"is 8enito$rinar( >7tre!ities e$rologic



47/66

Physical E*am

DiKc$lt /irwa(


So$rce Uneter!ine

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48/66

Physical E*am

Seat#elt sign


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/ccesse 9'20'09 I 8oogle @!age Search

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49/66

Physical E*am

Battle Sign

RaccoonZs >(es

C$llenMs Sign

8re(-+$rner Sign


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A. *. re an A./. "anDi5k Wiki!eia3

A. *. re an A./. "an Di5kWiki!eia3

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Adjuncts to Secondary Survey

Raiolog( Stanar e!ergent l!s

C-s&ine, C[R, Pel"is

2oc$se A#o!inal *onogra&h( in 8ra$!a /S+3 /itional l!s

Cat scan i!aging /ngiogra&h(

ole( Catheter Bloo at $rethral !eat$s N o ole( catheter

Pain Control +etan$s Stat$s /nti#iotics for o&en fract$res



51/66


52/66


53/66

Classic .adiograhical 5indings

Pel"ic ract$re


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54/66

Classic .adiograhic 5indings

e!$r ract$re


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55/66


>&i$ralAe!ato!a =ile =eningeal /rter(

S$#$ralAe!ato!a Briging Geins


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56/66


Dia&hrag!atic R$&t$re w' s&leenherniation


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aticr$&t$res&leenherniation.5&g/ccesse I 9'20'09 I Jahoo @!ages


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Wiene =eiastin$! I /ortic @n5$r(


www.tra$!a.org'ine7.&h&'!ain'i!age'T'&rint/ccesse 9'20'09 I Jahoo @!age Search


58/66

"efinitive Care Seconar( S$r"e( followe #(

raiogra&hic e"al$ation CatScan

Cons$ltation e$ros$rger( Ortho&eic S$rger( Gasc$lar S$rger(

+ransfer to Deniti"e Care

O&erating Roo! @CU

Aigher le"el facilit(



59/66

Case E*amle =r. Qones I T ('o !ale

in"ol"e in a rollo"er roatraKc accient an wase5ecte fro! the "ehicle.Patient was $nrestraine.Patient was not a!#$lator( onscene of accient an is#ro$ght into tra$!a #a( fore"al$ation. What concerns (o$ a#o$t stor(

irst Ste&s of >"al$ation an=anage!ent


Pete Prooehl ickr3


60/66

Case E*amle

>7a!

/wake, ia&horetic

P$lse N 120

BP N 90'F0

RR N 1H

O2 sat N 9TL

What o (o$ want to o ne7t



61/66

Case E*amle

Pre&aration Pri!ar( S$r"e(

/wake, alert, talking to &ro"ier Breathing

/#sent #reath so$ns on left What o (o$ want to o ne7t

Circ$lation Gital Signs /ccess Res$scitation

@G'O2'=onitor Disa#ilit(

8CS N 1T

>7&os$re1hana 7mer"ency +edicine

Collaborative


62/66

Case E*amle Chest t$#e &lace

R$sh of air hear consistent with &ne$!othora7

Re&eat Gital Signs P$lse 120

BP H0'T0

RR N 1

O2 sat N 99L RB=

What o (o$ want to o ne7t Patient co!&laining of a#o!inal &ain

>cch(!osis note o"er left ank

Res$scitation



63/66

Case E*amle Bloo Pro$ct /!inistration +ransfer to eniti"e care N O&erating

+heatre


Bone!esh ickr3

Conclusion


64/66

Conclusion /ssess!ent of the tra$!a &atient is a

stanar algorith! esigne to ens$re lifethreatening in5$ries o not get !isse

Pri!ar( S$r"e( ] Res$scitation

/irwa( Breathing

Circ$lation

Disa#ilit(

>7&os$re Seconar( S$r"e( Deniti"e Care



65/66


66/66

.eferences /!erican College of S$rgeons. /"ance

+ra$!a *ife S$&&ort. Fth >ition. 199. eliciano, Da"i et al. +ra$!a. Fth >ition.

=c8raw Aill. ew Jork. 200H.

Aock#erger, Ro#ert et al. RosenMs >!ergenc(=eicine% Conce&ts an Clinical Practice. Fth >ition. =os#(. 200F.

+intinalli et al. +intinalliMs >!ergenc(

=eicine% / Co!&rehensi"e St$( 8$ie. Fth >ition. =c8raw Aill. 200).

Lecture1 2 Advancedemergencytraumacourse Introductionandcourseoverview 1

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Transcript of Lecture1 2 Advancedemergencytraumacourse Introductionandcourseoverview 1