An Introduction Year 4 Tutorials

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Presentation transcript:

An Introduction Year 4 Tutorials Trauma An Introduction Year 4 Tutorials

HOW TO ASSESS THE TRAUMA PATIENT? PRIMARY SURVEY SECONDARY SURVEY

Primary Survey Safe approach Airway + c-spine protection Breathing Circulation (incl abdomen, pelvis and long bones) Disability Airway and shock discussed in more detail in talks to come

WHY? Identify and treat life threatening problems Treat greatest threat to life first Encourage treatment before definitive diagnosis necessarily made Encourage frequently reassessment

Airway Recognition of the obstructed airway Treatment of obstructed airway Trauma specific :Obstruction due to Secretions – blood, vomit, Reduced GCS Disrupted anatomy More in later talk

C-spine control Discuss how and when c-spine immobilisation should take place. Purpose of gap in front of collar etc

Breathing RR, Effort, Sats, Tracheal position, Percussion, Auscultation Trauma specific: Bruising & Wounds Deformity Tenderness S/C emphysema Can discuss tension pneumothorax, haemothorax – signs different when supine etc TREATMENT?

Circulation Pulse, CRT BP Heart sounds Trauma specific: TREATMENT? Abdominal exam Pelvic exam Long bones Mention FAST scanning TREATMENT?

Disability AVPU/GCS Pupils BM Gross focal neurology Trauma specific: Spinal examination PR

ATLS Principles – secondary survey Do not begin until primary survey completed Head-to-toe, front and back examination of all body regions Take more detailed history at this stage Tetanus status, last eat/drank, social circumstances

PREDICTING INJURIES

History / Scene Assessment

Assessing Mechanism of Injury Estimating how much energy transmitted to victim & where = what injuries to expect Type of deceleration (roll, tree, verge etc) Speed of impact ?trapped/ejected Extent of damage Use of protective measures (airbags, seatbelts) Extent of injury/death of other victims

Summary A structured approach to trauma is vital – ATLS provides this Primary survey – identify & treat life threatening problems Remember ABCDE with spinal immobilisation Secondary survey – detailed head to toe

Questions ?