Multisystem Trauma
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Transcript of Multisystem Trauma
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Multisystem Trauma
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Overview of the Critically Injured Patient
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Trauma is…
Single System: an injury involving a single isolated body system
Multiple System: an injury that involves two or more body systems
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Trauma System Compenents
Access Prehospital Initial Resuscitation Acute Care Rehabilitation
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Types of Trauma
Blunt Penetrating Blast Intentional Nonintentional
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Types of Injury
Primary: occurs at the time of injury Secondary: occurs as the result of
secondary insults (hypoxia, hypotension, infection etc.)
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Mitigating Factors
Younger than 5, older than 55 Medical / surgical hx. Substance abuse Severity of injury Time of injury to definitive care Quality of care
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General Approach
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Assessment
Primary Survey / resuscitation Secondary assessment Psychological, social and
environmental factors
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Mechanism of Injury and Kinematics
Mechanism=detailed cause or type of event
Kinematics = physics of trauma, how is energy dispersed
Part of primary survey…listen to prehospital caregivers
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Fundamentals of Initial Resuscitation
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Concepts Assessment and resuscitation occur
simultaneously Reassess frequently Establish priorities and anticipate needs Life over limb Preparedness, organization, communication Someone must be in control Do no further harm If condition progressively worsens…definitive
care is needed.
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Goals of Resuscitation
Oxygenation of vital tissues….it’s all about perfusion
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Primary Assessment
Subjective Data› Mechanism of Injury› Chief Complaint
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Airway / cervical spine Signs / Symptoms
› Decreased LOC› Agitation› Stridor› Cyanosis› Accessory Muscles› Hoarseness› No air movement
Treatment› Establish airway
without manipulation of cervical spine
› Jaw thrust› Suction› NP / OP airways› ETT
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Breathing
Signs / Symptoms› Cyanosis, decreased breath sounds, increased
resp. rate, decreased LOC, noisy resp., hypoxia, acidosis.
Diagnosis› Assess clinical presentation, ABG’s, oximetry
trends, CO2 monitoring, CXR Treatment
› High flow O2, assist ventilation, treat tension pnuemo, open pnuemo, flail chest or hemothorax, PAIN MANAGEMENT
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Circulation
Signs of hypovolemic shock› Altered LOC, tachycardia, hypotension,
tachypnea, cool diaphoretic skin, low UOP, slow capillary refill time.
Diagnosis› CBC, PT, PTT, X rays, DPL, US, arteriograms
Treatment of hypovolemia› Direct pressure to external bleeding, high flow
O2, 2 lg bore IV’s, fluids, blood› Rule out sources of obstructive shock
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Spinal Immobilization Based on mechanism, not neuro deficit SCI may occur with or without bony
involvement High index of suspicion
› Pain, paralysis, paresthesia, ptosis, priapism, presenting position, pregnancy, MOI.
Diagnostics› Initial AP/ lateral to include C-7 and T-1› Correlate with physical exam› CT
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Disability / Neuro Assessment
AVPU Trend Glasgow Coma Scale score Trend pupillary size Assess motor function of all four ext. Diagnostics…rule out
› Decreased perfusion or direct cerebral injury, Drugs / ETOH, Hypoxia, Hypotension
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Disability – Treatment
Complete primary survey Treat life threatening injury Complete secondary survey Rapid resuscitation Avoid prolonged hyperventilation Avoid hypotension SBP>90 Serial monitoring of VS / NS Consider Narcan or Mannitol
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Exposure
Judicious nakedness. Keep patients WARM. Monitor temperature carefully
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Secondary Survey
Should not be initialized until life threatening injuries are treated and primary assessment is complete
AMPLE History Head to Toe physical
exam, including posterior surfaces
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Preparation for Further Diagnostics
Foley (if no contraindications) › maintain UOP >30 ml / hr
Decompress stomach with NG› If no CSF leak, midface fx
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Special Populations Pediatrics
Geriatrics
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The Pregnant Trauma Patient Resuscitation
priorities are identical to those on non-pregnant trauma patient.
Consult OB resources early in resuscitation.