Critically injured patient

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Presentation transcript:

Critically injured patient Prof Mohan de Silva

Essential words to remember TRIMODAL distribution of deaths ATLS Primary survey Secondary survey

The Critically Injured Trauma commonest cause of hospital admissions in Sri Lanka since 1995 commonest cause of death below the age of 40 in many countries

The critically injured Majority died due to inadequate treatment Initial treatment determines the outcome Early intervention is essential

GOLDEN HOUR OF TRAUMA

TRIMODAL DISTRIBUTION OF DEATHS Immediate 1st few hours Few days after admission

Conventional approach History Examination Investigations Diagnosis Treatment

How it all started Another accident ………..

New approach… A T L S Examination ) Resuscitation ( Treatment ) Initial assessment ( History, Examination ) Resuscitation ( Treatment ) WILL BEGIN SIMALTANEOUSLY Recognize and treat the most life threatening injury first

TRAUMA KILLS ACCORDING TO A SEQUENCE ! Acute airway obstruction - The quickest killer Inadequate breathing Hypovolaemia Expanding intra cranial haematoma

Hypoxia and Hypovolaemia are the main killers Hypoxia kills before hypovolaemia

PRIMARY SURVEY SECONDARY SURVEY

Initial assessment and resuscitation Primary survey A ir way with cervical spine control B reathing C irculation D isability (Neurological ) E xposure F oleys catheter

Airway obstruction recognition and treatment Identify – SPEAK TO THE PATIENT establish OXYGEN protect OXYGEN maintain OXYGEN 10 L / minute

Immobilisation of the C spine sand bag collar tape

B reathing Inspection - wall movements,ext. injuries etc Palpation - cripitus percussion - hyperesonence or stony dullness Auscultation - breath sounds absent RESPIRATORY RATE

Circulation hypovolaemic shock Action PULSE RATE , B P All critically injured patients are in hypovolaemic shock Action PULSE RATE , B P 2 Big drips to Two big veins 2 L of N Saline fast in Blood cross matching

Glasgow coma score Expose the patient Where is the scissor ! A V P U D isability (Neurological ) A V P U Glasgow coma score Expose the patient Where is the scissor !

Secondary survey Pulse - BP – RR -Temperature Systematic examination from head to toe LOG ROLL Finger to all orifices Minor injuries

History A M P L E A llergies M edications P ast illnesses L ast meal E vents leading to the injury

Outcome ?

TAKE HOME MESSAGE What is the first thing you do when you get a critically injured ? What is the quickest killer of the injured? What is trimodal distribution of deaths? What is the difference between conventional and ATLS approach What do you do in Primary and secondary surveys?