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trauma patient
patient.
Discussion on the case
Recommendation
MCQ
Case
Male patient 28 years presented to the ER
both sides.
Blood pressure: 100/60 mmHg.
Temp: 37.1C
Exposure
No major bleeding
No major deformity
Discussion on part
one of the lecture
Types of assessment
1. Primary Survey and resuscitation
2. Secondary Survey
Identification of LIFE-
THREATENING emergencies
Assess Change - Reassess
Initiation of LIFE-SAVING
measures (CPR)
Illinois EMSC 9
5 second Round
Pt is conscious or not
Airway
Ventilation
Signs of massive external
hemorrhage
There is any deformity
Skin color and temp with feeling
Illinois EMSC 10
Primary Survey
Airway/
Cervical Spine Control
Breathing
Circulation
Disability (neurological)
Expose
Illinois EMSC 11
Assessing Airway
Is the airway:
At risk?
Obstructed?
AIRWAY INTERVENTIONS
Jaw thrust Vs Head tilt.
Deliver Oxygen (mask
with reservoir).
Use Rigid suction.
Secure airway.
Illinois EMSC 13
5 Chest clues in the
neck
Wounds
Distended neck
veins
Tracheal
position
Surgical
emphysema
Laryngeal
crepitus
CERVICAL SPINE STABILIZATION
Palpation
Tender points, equal
expansion
Percussion
No abnormal note
BREATHING INTERVENTIONS
Illinois EMSC 18
Fatal Chest conditions?
Tension pneumothorax
Cardiac tamponade
Flail chest
Massive hemothorax
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CIRCULATORY ASSESSMENT
Carotid pulse (absent or
present)
Capillary refill
Skin color
Skin temperature
Sites of bleeding
Illinois EMSC 20
CIRCULATORY INTERVENTIONS
If central pulse is absent, begin
CPR
Apply direct pressure to open
wounds
IV access (2 wide bore
cannulae14/16G).
Fluids (colloids Vs crystalloids) 20ml/Kg
Peripheral Vs central line?
21
Dysfunction of the
CNS
Aims
Rapid neurological
assessment
Alert; Voice; Pain;
Unresponsive
Pupils
Mini-neurological
assessment
GCS score / AVPU
Pupils
Lateralising signs
Blood sugar
23
Exposure and
environment
Aims
entire patient
Care when removing tight trousers
Prevent hypothermia
Patient dignity
Illinois EMSC 27
Radiology
Once the patient is stabilized the patient is
sent to radiology for the survery:
Cervical spine X-ray (AP and lateral view)
Chest X- ray (Rib cage)
Pelvis X-ray
Abdomen and Pelvis U/S
CT brain is ordered if there is suspicion of
head trauma
X-ray of extremities if fracture is suspected.
Chest X-Ray
Part 2 case
Patient returned form the radiology
department complaining of severe chest pain
and could not lay down on his back for
suturing of the cut wound in the forehead
Patient received the following medication:
1500 cc of normal saline
cefoperazone 1.5 gm IV
Mediastinal widening
mind.
Aortic disruption should always be suspected
Paraplegia or paraparesis
90%.
Minimally invasive repair using aortic stenting
techniques are also being used
MANAGEMENT OPEN
PNEUMOTHORAX
Ensure adequate
airway
100% oxygen
Seal open wound
Load & Go
IV access en route Courtesy of David
Notify Medical Effron, M.D.
Direction
SEALING THE OPEN WOUND
Asherman chest seal is very effective
SEALING THE OPEN WOUND
You can use impervious material taped on
three sides
TENSION
PNEUMOTHORAX
MANAGEMENT
TENSION PNEUMOTHORAX
Ensure adequate airway
100% oxygen
Needle decompression if indicated
Load & Go
IV access en route
Notify Medical Direction
MCQ
1. Which of the following is true in regards to a
traumatic aortic rupture?
A. 90 mmHg.
B. 100 mmHg.
C. 110 mmHg.
D. 70 mmHg.
4. The initial management of a poly-trauma patient
should include the following order:
A. Conscious level, secure airway, assess circulation ,
control cervical spine, assist ventilation and
exposure.
B. Secure airway, control cervical spine, assess
circulation, follow up conscious level and assist
ventilation and exposure.
C. Secure airway, control cervical spine, assist
ventilation, assess circulation, follow up conscious
level and exposure.
D. control cervical spine , secure airway, assist
ventilation, assess circulation, follow up conscious
level and exposure.
5-Which of the following is the BEST screening
test for detecting traumatic aortic injury in a
stable patient?
(A) Chest radiograph.
secondary survey.
Team work is standard in management of trauma
patients.
Routine investigation should be implemented as a