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LECTURE 1QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETHINITIAL ASSESSMENT & MANAGEMENTPOLYTRAUMA**MANAGEMENT OF POLYTRAUMA

MANAGEMENT OF POLYTRAUMA

What is the sequence of priorities in assessing this patient?

CASE SCENARIOQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**44-year-old male driver who crashed head-on into a wallPatient found unresponsive at the sceneArrives at hospital via basic life support with c-collar in place and strapped to a backboard; Lions ambulance assisting ventilations with bag-maskMANAGEMENT OF POLYTRAUMA


OBJECTIVESQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Apply principles of primary and secondary surveysIdentify management prioritiesInstitute appropriate resuscitation and monitoring proceduresRecognize the value of the patient history and biomechanics of injuryAnticipate and manage pitfallsMANAGEMENT OF POLYTRAUMA


STANDARD PRECAUTIONSQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**CapGownGlovesMaskShoe coversGoggles / face shieldMANAGEMENT OF POLYTRAUMA


CONCEPT OF INITIAL ASSESSMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Primary survey and resuscitation of vital functions are done simultaneously using a team approach.

Definitive CareReevaluationAdjunctsAdjunctsPrimary SurveyResuscitationReevaluationDetailedSecondary SurveyMANAGEMENT OF POLYTRAUMA


QUICK ASSESSMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**What is a quick, simple way to assess a patient in 10 seconds?MANAGEMENT OF POLYTRAUMA


QUICK ASSESSMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Identify yourselfAsk the patient his or her nameAsk the patient what happenedMANAGEMENT OF POLYTRAUMA


QUICK ASSESSMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**APPROPRIATE RESPONSE CONFIRMS : MANAGEMENT OF POLYTRAUMA


PRIMARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Airway with c-spine protectionBreathing with adequate oxygenationCirculation with hemorrhage controlDisabilityExposure / EnvironmentMANAGEMENT OF POLYTRAUMA


PRIMARY SURVEY : AIRWAYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Establish patent airway and protect c-spine Occult airway injury

Progressive loss of airway

Equipment failure

Inability to intubate



PRIMARY SURVEY : BREATHINGQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Assess and ensure adequate oxygenation and ventilation

Respiratory rate Chest movement Air entry Oxygen saturation

Airway versus ventilation problem?

latrogenic pneumothoraxortension pneumothorax?



PRIMARY SURVEY : CIRCULATIONQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Assess for organ perfusion by : Level of consciousness Skin color and temperature Pulse rate and characterControl hemorrhageRestore volumeReassess patientManagement for organ perfusion by :

Elderly Children Athletes MedicationsMANAGEMENT OF POLYTRAUMA


PRIMARY SURVEY : DISABILITYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH** Baseline neurologic evaluation Glasgow Coma Scale score Pupillary responseObserve for neurologic deteriorationCautionMANAGEMENT OF POLYTRAUMA


PRIMARY SURVEY EXPOSURE / ENVIRONMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Completely undress the patientPrevent hypothermiaMissed injuriesMANAGEMENT OF POLYTRAUMA


RESUSCITATIONQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH** Protect and secure airway Ventilate and oxygenate Stop the bleeding! Vigorous shock therapy Protect from hypothermiaMANAGEMENT OF POLYTRAUMA


ADJUNCTS TO PRIMARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**PRIMARY SURVEYVital signsABGsPulseoximeterand CO2Urinary / gastric cathetersunless contraindicatedUrinaryoutputECGMANAGEMENT OF POLYTRAUMA


ADJUNCTS TO PRIMARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**DIAGNOSTIC TOOLSMANAGEMENT OF POLYTRAUMA


ADJUNCTS TO PRIMARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**DIAGNOSTIC TOOLS

FastDPLMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**The complete history and physical examinationWhen to start the secondary survey?After Primary survey is completed ABCDEs are reassessed Vital functions are returning to normalComponents of the secondary survey History Physical exam: Head to toe Complete neurologic exam Special diagnostic tests ReevaluationMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**History

AllergiesMedicationsPast illnessesLast mealEvents / Environment / MechanismMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Mechanisms of InjuryMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Head External exam Scalp palpation Comprehensive eye and ear exam Including visual acuityUnconsciousnessPeriorbital edemaOccluded auditory canalMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Maxillofacial Bony crepitus Deformity MalocclusionMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Neck (Soft Tissues) Mechanism: Blunt vs penetrating Symptoms: Airway obstruction, hoarseness Findings: Crepitus, hematoma, stridor, bruit

Delayed symptoms and signsProgressive airway obstructionOccult injuriesMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Chest Inspect Palpate Percuss Auscultate X-raysMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Abdomen Inspect / Auscultate Palpate / Percuss Reevaluate Special studiesHollow viscous injuryRetroperitoneal injuryMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Perineum Contusions, hematomas, lacerations, urethral blood

Rectum Sphincter tone, high-riding prostate, pelvic fracture, rectal wall integrity, blood

VaginaBlood, lacerationsUrethral injuryPregnancyMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**PelvisPain on palpationLeg length unequalInstabilityX-rays as needed

Excessive pelvic manipulationUnderestimating pelvic blood loss



SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**ExtremitiesContusion, deformityPainPerfusionPeripheral neurovascular statusX-rays as neededMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**

Potential blood lossMissed fracturesSoft tissue or ligamentous injuryCompartment syndrome (especially with altered sensorium / hypotension)MANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Neurologic: BrainGCS Pupil size and reactionLateralizing signsFrequent reevaluationPrevent secondary brain injuryEarlyneurosurgicalconsultMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Neurologic: Spinal AssessmentWhole spineTenderness and swellingComplete motor and sensory examsReflexesImaging studies

Altered sensoriumInability to cooperate with clinical examMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Neurologic: Spine and CordConduct an in-depth evaluation of the patients spine and spinal cordEarly neurosurgical / orthopedic consultMANAGEMENT OF POLYTRAUMA


SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**NeurologicIncomplete immobilizationNeurologic deteriorationMANAGEMENT OF POLYTRAUMA


ADJUNCTS TO SECONDARY SURVEYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH** Special Diagnostic Tests as IndicatedPatient deterioration Delay of transferDeterioration during transferPoor communicationMANAGEMENT OF POLYTRAUMA


PAIN MANAGEMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Relief of pain / anxiety as appropriateAdminister intravenouslyCareful monitoring is essentialMANAGEMENT OF POLYTRAUMA


SUMMARYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Definitive CareReevaluationAdjunctsAdjunctsPrimary SurveyResuscitationReevaluationDetailedSecondary SurveyMANAGEMENT OF POLYTRAUMA


ANY QUESTIONS ?

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**MANAGEMENT OF POLYTRAUMA


LECTURE 1QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETHTRAUMA TEAMCONCEPT & PHILOSOPHY**MANAGEMENT OF POLYTRAUMA


INTRODUCTIONQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**TRAUMA TEAMMany studies in developing countries have shown that > 30% of total hospital death is due to trauma.A well integrated trauma system based upon TEAMWORK and PARTNERING can reduce the mortality rate to less than 10%.MANAGEMENT OF POLYTRAUMA


TEAM WORKQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**ORGANISATION OF TEAMWORK

Vertical Team Organization

Horizontal Team OrganizationMANAGEMENT OF POLYTRAUMA


VERTICAL TEAM ORGANISATIONQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**

Command & instructions are determined by the Team Leader.Task carried out sequentially.Focused on Team Leader.Inefficient work culture.MANAGEMENT OF POLYTRAUMA


VERTICAL TEAMQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**MANAGEMENT OF POLYTRAUMA


HORIZONTAL TEAM ORGANISATIONQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**

All members carry out individual tasks simultaneously.Not focused on any particular team member or team leader.Enhance Team Performance and Improved Outcome.Most efficient organisationMANAGEMENT OF POLYTRAUMA


HORIZONTAL TEAM QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**MANAGEMENT OF POLYTRAUMA


TEAM WORKQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Features of an efficient teamworkTask divided into manageable units.Specifically allocated to individual members.Task evenly divided among Team Members.Task carried out SIMULTANEOUSLY.MANAGEMENT OF POLYTRAUMA


TRAUMA TEAMQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Current System in Managing Multiple Trauma in Malaysia.Resuscitation carried out with a mixture of vertical and horizontal task distribution.Variable team size.Members tend to arrive at different times.Lack of overall coordination.Junior doctors.MANAGEMENT OF POLYTRAUMA


TRAUMA TEAMQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Trauma Team Structures and FunctionsOptimal size depends on the severity of injuries and experience of the individual team members.Ideally an 8-member team.The strength of the team is as strong as its weakest link.MANAGEMENT OF POLYTRAUMA


QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**MANAGEMENT OF POLYTRAUMA


RESUSCITATION ZONEQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Resuscitation Zone LayoutA dedicated and proper working area to facilitate performance of the Trauma Team.Golf Swing movement.MANAGEMENT OF POLYTRAUMA


ROLE OF TEAM LEADERQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Team Leader :The most experienced personnelPerform the most important aspects of the management e.g primary survey and resuscitation procedures.MANAGEMENT OF POLYTRAUMA


TRAUMA TEAMQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Development of Trauma Team in MalaysiaPhase IFirst 5 - 10 minutes : 3 Member Team from EDPhase IIFrom 3 - 6 hours : 6 Member Team additional members from the respective departments.MANAGEMENT OF POLYTRAUMA


SUMMARYQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**Trauma should be managed as smoothly and as efficiently as a PIT STOP in a FORMULA ONE RACEMANAGEMENT OF POLYTRAUMA


ANY QUESTIONS ?

INITIAL ASSESSMENTQUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN ELIZABETH**MANAGEMENT OF POLYTRAUMA


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