Trauma assessment in The Emergency department

Trauma assessment in The Emergency department

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  Basic Trauma Assessment By: MohammedAwad Elameen BSc. DOHM. MBBS Sr.ANESTHESIA TECHNOLOGIST
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  Trauma definition  Cellulardisruption caused by environmental energy that is beyond the body resilience, which is compounded by cell death due to ischemia or disruption.  It is the most common cause of death for all individuals between the ages of 1 to 44 years, and is the 3rd most common cause of death regard less of age.
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  Magnitude of theproblem  Majorities of injures are not life threatening or limb threatening  2-50% of life threatening injuries are missed during primary and secondary survey.
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  Mechanism of injury The physician must understand the kinematics of trauma and integrate this knowledge with the trauma producing episode Mechanism Features Covert injury Lt sided impact Lateral pelvis compression Lt sided pneumothorax Splenic rupture
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  Time line concept It is critical time window in which we can intervene for a positive treatment outcome, before the loss of compensatory mechanisms.  Patient is at their normal baseline, which can be called time zero  Timely prioritize interventions are necessary to prevent death and disability o Both assessment and response should take place in the time window prior to irreversible damage or death Golden hour; Period immediately following trauma in which rapid assessment, diagnosis, and stabilization must occur
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  Primary survey  Initialassessment and resuscitation of vital functions. Prioritization is based on ABCs  Goal is to identify and treat conditions that constitutes an immediate thread to life  The ATLS ( advanced trauma life support) system delineates an order of priorities set by cABCDEF; that is Airway, Breathing, Circulation, Disability (neurology) Exposure and foley catheter  This priorities are instituted upon the time dependance principle
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  C:Exsanguinating External Hemorrhage Exsanguinating External Hemorrhage from massive arterial bleeding needs to be controlled even before the airway is managed  Application of packs and pressure  Hemostatic dressings that contain local coagulation agents  Application of a tourniquet proximal to the wound  Urgent surgical control of the bleeding to reperfuse the limb
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  Identification of thesource of hemorrhage  Whole Body Computed tomography (WBCT) from the head to pelvis with IV contrast, is the gold standard investigation in patients with signs and symptoms of multiple injuries or deranged physiology.  Is time critical investigation , should be obtained as early as possible in severely injured patient  Focused abdominal sonography for trauma (FAST) scan if immediately available may also be useful to locate the major source of hemorrhage  Detect free fluid in abdomen or pericardium
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  Airway management withcervical spine protection  All patients with blunt trauma require cervical spine immobilization until injury is excluded.
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  Airway  Assess patency Jaw thrust/ chin left initially to open airway  Clear foreign bodies  Insert oral or nasal airway if necessary  Establishing definitive airway (Nasotracheal, Orotracheal, surgical airway)
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  Breathing and ventilation Inspect, auscultate and palpate  Ensure adequate ventilation and oxygenation  identify and treat injuries that may immediately impair ventilation: - Tension pneumothorax - Flial chest and pulmonary contusion - Massive hemothorax - Open pneumothorax - Major air leak due to tracheobronchial injury
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  Circulation with hemorrhagecontrol  Access circulatory stayus: capillary refill, skin color, Measure BP and pulse at least every 5 minutes in patients with significant blood loss until normal vital signs are restored  IV access for fluid resuscitation with 2 large peripheral catheters  Intera-ossseous in proximal humerus or tibia in case of difficult IV line  In seriously injured patient in shock; -ABG - blood cross- matching for possible transfusion -Coagulation studies
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  Disability  Rapid neurologicexam  Glasgow coma scale ( GCS) is quantifiable determination of neurologic function that is useful for treatment and prognosis  Protect cervical spine with collar and thoracolumbar spine using standard log roll technique until spinal injury is excluded.
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  Log rolling log rolling.jpg
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  Exposure  Seriously illpatient must have all of their clothing removed, covered with warm planked
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  Foley catheter  Placementof urinary catheter is considered part of the resuscitation phase that take place during the primary survey  It is contraindicated when urethral transection is suspected, as in pelvic fracture.  Perform retrograde urethrogram before catheter insertion
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  THANKS