TRAUMA Submitted By:

Preeti Sood

MSc Nursing 1st Year

Trauma

Terminology:• Injury = The result of harmful event that arises

from the release of specific forms of energy.• “Trauma” = Injury of one or more systems,

that results in excessive bleeding and may affect the normal body functioning.

EPIDEMIOLOGY• 3242 persons die each day around the world.• 50 million people are disabled or injured each year.• India : 1%of motor vehicles in the world but bears the

burden of 6% of global vehicular accidents.• Unfortunately, a majority of trauma survivors are either

confined to bed or wheel chair for the rest of their lives.• The tragedy of India :

78% of the victims – men, 20 to 44 years, causing significant impact on productivity.• A vehicular accident reported every 3 min and a death

every 6 min on Indian roads

AIRWAY DOCTOR

CIRCULATION NURSE

ORTHO REGISTRAR

SCRUB NURSE

TEAM LEADERSOCIAL WORKER

RADIOGRAPHER

CIRCULATION DOCTOR

AIRWAY NURSE

TRAUMA TEAM

Trauma deaths

FIRST PEAK • Within minutes of injury • Due to major neurological or vascular injury • Medical treatment can rarely improve outcome

SECOND PEAK • Occurs during the 'golden hour' • Due to intracranial haematoma, major thoracic or abdominal injury • Primary focus of intervention for the Advanced Trauma Life Support

(ATLS) methodology

THIRD PEAK • Occurs after days or weeks • Due to sepsis and multiple organ failure

Trauma

• Preparation and triage• Primary Survey• Adjuncts to primary survey• Secondary Survey • Adjuncts to secondary survey• Definitive treatment• Records, Consent, Forensic evidence

Preparation and TriagePre-

Hospital phase

Pre-hospital agency co-ordination

Call on emergency

number

Mobilizes the trauma team to ED

Hospital phase

Advance planning

Saves time

Triage

The process of categorizing victims or mass casualties based on their need for treatment and the resources available.

ITS MAIN GOALS ARE:• Prevent avoidable deaths.• Ensure proper initial treatment with a minimal

time frame.• Avoid misusing asserts on hopeless cases.

MULTIPLE CASUALTIES

No. of patients and the severity of their injuries do not exceed the ability of the facility to provide care.

MASS CASUALTIES

The no. of patients and the severity of their injuries exceed the ability of the facility to provide care.

Assessment of the injured patient Primary survey and resuscitation A = Airway and cervical spine B = Breathing C = Circulation and hemorrhage control D = Disability or Dysfunction of the central

nervous system E = Exposure

Airway and cervical spine• Always assume that patient has cervical spine

injury• If patient can talk then he is able to maintain

own airway• If airway compromised initially attempt a chin

lift and clear airway of foreign bodies.• Intubate or cricothyroidotomy • Give 100% Oxygen

Breathing

• Check position of trachea, respiratory rate and air entry

• If clinical evidence of tension 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

Circulation and hemorrhage control

• Assess pulse, capillary return and state of neck veins

• Identify exsanguinating hemorrhage and apply direct pressure.

• Place two large calibre intravenous cannulas Give intravenous fluids

• Attach patient to ECG monitor

Disability or Dysfunction of the central nervous system

Rapid assessment of neurologic status to identify life-threatening injury• Pupil size and response• Mental status (Glasscow coma scale)• Motor and sensory exam

Exposure

Head to toe examination of the patient for injury• Pitfalls

- Maintenance of spine precautions

- Prevention of heat loss

- Under cervical collar- Back and flanks• Undress the patient completely but prevent

hypothermia.• Logrolling and looking for back of the pt. is very

important

Adjuncts to the Primary Survey

• Exams during or after primary survey to aid in identifying life-threatening injuries

- ECG- Pulse oximetry- Chest x-ray- Pelvis x-ray- ABGS- Catheters

- Focused abdominal sonogram for trauma (FAST)- Diagnostic peritoneal lavage (DPL)o Resuscitation may be required in some cases.

Secondary surveySecondary survey does not begin until the primary survey is completed, resuscitative efforts are established and patient is demonstrating normalization of vital functions.

It includes:• Head to toe evaluation• AMPLE history

- Allergy

- Medications currently taking

- Past illness

- Last meal

- Event/environment related to injury.• Physical examination• Reassessment of all vital organs

Adjuncts to the secondary survey

• CT SCAN• CONTRAST STUDIES• EXTREMITY XRAY• ENDOSCOPY • ULTRASONOGRAPHY

Definitive Treatment

Treatment plans, especially for multiple injuries, based on clinical status and specific injuries.• AFTER identifying the patients injury.• Managing life threatening problems• Obtaining special studies.• If the patients injuries exceed the capabilities

of the institution.

Take home message

• ABCDE approach.• Treat greatest threat to life.• Definitive diagnosis is not immediately

important.• Time is the essence.• Do no further harm the patient.