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MANAGEMENT OF MULTIPLE TRAUMA.

DR. D. V. KANISHKA KAMAL

Where should we start ? ?

DEATH FOLLOWING INJURY


SHOWS A DISTINCT TRIMODAL PATTERN. DR. DONALD TRUNKEY CHAIRMAN OF DEPT. OF SURGERY OREGAN, USA.
IMMEDIATE DEATHS - 50% - within minutes EARLY DEATHS - 30% - 1-3 hours LATE DEATHS - 20% - 2-4 weeks * CONCEPT OF GOLDEN HOURS OF TRAUMA !

HISTORY
1970- DR. JAMES STYNER AMERICAN ORTHOPAEDIC SURGEON

INTRODUCED A STRUCTURED TRAUMA MANAGEMENT TRAINING PROGRAMME


AMERICAN COLLEGE OF SURGEONS DEVELOPED ATLS EDUCATIONAL PACKAGE.

PHILOSOPHY
TREAT LETHAL INJURY FIRST, THEN REASSESS,

AND TREAT AGAIN !

ATLS COMPONENT STEPS


1. PRIMARY SURVEY - IDENTIFY WHAT IS KILLING THE PATIENT. 2. RESUSCITATION - TREAT WHAT IS KILLING THE PATIENT.

3. SECONDARY SURVEY - PROCEED TO IDENTIFY ALL OTHR INJURIES.


4. DEFINITIVE CARE - DEVELOP A DEFINITIVE MANAGEMENT PLAN.

PRIMARY SURVEY
SURVEY OF.

1. 2. 3. 4. 5.

AIRWAY WITH CERVICAL SPINAL CONTROL BREATHING AND VENTILATION CIRCULATION WITH CONTROL OF HAEMORRHAGE DYSFUNCTION OF THE CNS EXPOSURE IN A CONTROLLED ENVIRONMENT

AIRWAY OBSTRUCTION KILLS IMMEDIATELY !

SECURING AIRWAY WITH


CERVICAL SPINAL CONTROL
CONTROL CERVICAL SPINE MANUAL INLINE CONTROL COLLAR/ SAND BAG/ HEAD TAPE ASSESS AIRWAY AIRWAY MANAGEMENT

AIRWAY MANAGEMENT
1. CONTROL CERVICAL SPINE MANUAL INLINE CONTROL COLLAR/ SAND BAG/ HEAD TAPE 2. CLEAR AIRWAY TWO FINGER SWEEP SUCTION 3. MAINTAIN AIRWAY CHIN LIFT / JAW THRUST 4. PROVIDE AIRWAY AIRWAY DEVICES CRICOTHYROIDOTOMY 5. O2 14 L / MINUTE

BREATHING AND VENTILATION


ASSESS - TO IDENTIFY IMMEDIATELY LIFE THREATENING CONDITIONS 1. 2. 3. 4. TENSION PNEUMOTHORAX MASSIVE HAEMOTHORAX OPEN PNEUMOTHORAX FLAIL CHEST

Open pneumothorax

Tension pneumothorax

Haemothorax

Flail chest

PROBLEMS IN CIRCULATION
SHOCK. Hypovolaemic, cardiogenic Cardiac tamponade leading to shock.

CIRCULATION AND CONTROL OF HAEMORRHAGE


ASSESSMENT FOR SIGNS OF SHOCK CAUSE OF SHOCK ASSESS THE DEGREE OF BLOOD LOSS CLASS I, II, III, IV SITE OF BLOOD LOSS Blood on the floor and four more

MANAGEMNT OF A PATIENT IN SHOCK


VASCULAR ACCESS PERIPHERAL VENOUS CANNULATION VENOUS CUTDOWN INTRAOSSEOUS TRANSFUSION

DRAW BLOOD FOR GROUPING & DT AT THE SAME TIME,


RESUSCITATION TRANSFUSE 2L OF HARTMAAN SOLN. ASSESS RESPONSE IMMEDIATE AND SUSTAINED TRANSIENT & LATER DETERIORATION NO RESPONSE

DYSFUNCTION OF THE CNS


ASSESSMENT OF NEUROLOGICAL STATUS AVPU ALERT RESPONDS TO VOICE RESPONDS TO PAIN UNRESPONSIVE

MONITORING

PULSE OXYMETER BLOOD PRESSURE & HEART RATE ECG URINE OUTPUT TEMPERATURE

INVESTIGATIONS DURING INITIAL STAGE


XRAY CERVICAL SPINE LATERAL FILM XRAY CHEST SUPINE PA XRAY PELVIS - AP

HISTORY
1. 2. 3. 4. 5. ALLERGIES MEDICATIONS PAST MEDICAL HISTORY LAST MEAL EVENT LEADING TO THE INJURY

EXPOSURE OF THE PATIENT


EXPOSE IN A CONTROLLED ENVIRONMENT!

FURTHER DECISION MAKING


RESPONSE TO PRIMARY SURVEY AND RESUSCITATION INFLUENCES FURTHER DECISION MAKING 1. 2. 3. 4. NO LIFE THREATENING CONDITION SUSTAINED RESPONSE TRANSIENT RESPONSE NO RESPONSE

SECONDARY SURVEY
HEAD TO TOE EXAMINATION HEAD, FACE, NECK, THORAX , ABDOMEN, PELVIS, SPINAL INJURIES, EXTREMITIES VITAL SIGNS MONITORING DEVICES ARE IN SITU DETAILED RADIOGRAPHIC PROCEDURES

POTENTIALLY LIFE THREATNING INJURIES - SECONDARY SURVEY


1. 2. 3. 4. 5. 6. PULMONARY CONTUSION MYOCARDIAL CONTUSIONS AORTIC TEAR DIAPHRAGMATIC TEAR OESOPHAGEAL TEAR TRACHEOBRONCHIAL TEAR

DEFINITIVE CARE PLAN

DECISION ON OWNERSHIP ATTENTION OF THE OTHER SPECIALISTS

THANK YOU !