Polytrauma
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Transcript of Polytrauma
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POLYTRAUMA WITH AIRWAY AND
CIRCULATORY PROBLEMS
Dr. Mansoor KhanMBBS, FCPS I,
Resident, Surgical “C”, KTHPeshawar.
Sep 29th, 2009
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“ Trauma to two or more than two systems of the body with
associated signs and symptoms ”
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Within minutes
Within Hours
(Golden Hour)
Within
Days or weeks
Major Vascular/neurological Trauma Medical treatment usually
not helpful
Intracranial hematoma, major Thoracic/abdominal
trauma
Due to sepsis &
multi organ failure
M
o
R
T
A
L
I
T
y
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Triage 'do the most for the most'
T
R
I
A
G
E
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Cat Definition Colour Treatment Example
P1 Life-Threatening
Red Immediate Tension Pneumothorax
P2 Urgent Yellow Urgent Fracture femur
P3 Minor Green Delayed Sprained ankle
P4 Dead White
TRIAGE
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Walk Airway Respiratory rate Pulse rate or Capillary return
T
R
I
A
G
E
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Triage 2
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Primary survey and resuscitation
A = Airway and cervical spine B = Breathing C = Circulation and haemorrhage control D = Dysfunction of the central nervous system E = Exposure
Secondary survey
Definitive treatment
Call for help
ASSESSMENt
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Always assume cervical spine injury
If patient can talk then no airway problem
If airway compromised initially attempt a chin lift and clear airway of foreign bodies
Intubate or cricothyroidotomy Give 100% Oxygen
Airway and cervical spine
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Airway
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OROPHYRINGEAL AIRWAY
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Choking
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ENDOTRACHEAL INTUBATION
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LMA
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Check position of trachea, respiratory rate and air entryTension pneumothorax will need immediate relief Place venous cannula through second intercostal space in the mid-clavicular line
If open chest wound seal with occlusive dressing
BREATHING
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PNEUMOTHORAX
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FLAIL CHEST
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EMERGENCY DECOMPRESSION
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EMERGENCY DECOMPRESSION
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CHEST DRAIN
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OCCLUSIVE CHEST DRESSING
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Assess pulse, capillary return and state of neck veins Identify exsanguinating haemorrhage and apply direct pressure
Place two large calibre intravenous cannulas Give intravenous fluids (crystalloid or colloid)Attach patient to ECG monitor
Circulation and haemorrhage control
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Bleeding from hand
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BLEEDING CONTROL FROM ARM
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BLEEDING CONTROL FROM GROIN
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Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive
Assess pupil size, equality and responsiveness
Dysfunction
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Avoid hypothermia
Fully undress patients Avoid hypothermia
Exposure
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Check all causalities
Quick assessNo moving
Apply life-saving treatment
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Treat
in the position foundfirst life-threatening or
potentially serious injuries
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THANKS