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Initial Assessment of Trauma Patient

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Presentation on theme: "Initial Assessment of Trauma Patient"— Presentation transcript:

1 Initial Assessment of Trauma Patient
Dr Amjad Obeid Consultant Emergency Medicine KSUMC

2 Case Scenario 44-year-old male driver who crashed head-on into a wall
Patient found unresponsive at the scene Arrives at hospital via basic life support with c-collar in place and strapped to a backboard; technicians assisting ventilations with bag-mask

3 Standard Precautions Cap Gown Gloves Mask Shoe covers
Protective eyewear / face shield

4 Initial Assessment Primary survey and resuscitation of vital functions are done simultaneously using a team approach.

5 Concepts of Initial Assessment

6 What is a quick, simple way to assess a patient in 10 seconds?
Quick Assessment What is a quick, simple way to assess a patient in 10 seconds?

7 What is a quick, simple way to assess a patient in 10 seconds?
Quick Assessment What is a quick, simple way to assess a patient in 10 seconds? Ask the patient his or her name Ask the patient what happened

8 Appropriate Response Confirms
A Patent airway B Sufficient air reserve to permit speech C Sufficient perfusion D Clear sensorium

9 Airway with c-spine protection Breathing and ventilation
Primary Survey Airway with c-spine protection Breathing and ventilation Circulation with hemorrhage control Disability: Neuro status Exposure / Environmental control

10 The priorities are the same for all patients.
Primary Survey The priorities are the same for all patients.

11 Special Populations Elderly Infants and Children Pregnant Women Obese
Athletes

12 Primary Survey Establish patent airway and protect c-spine Pitfalls
Occult airway injury Progressive loss of airway Equipment failure Inability to intubate Establish patent airway and protect c-spine

13 Primary Survey Respiratory rate Chest movement
Breathing and Ventilation Respiratory rate Chest movement Air entry Oxygen saturation Assess and ensure adequate oxygenation and ventilation

14 Primary Survey Pitfalls Breathing and Ventilation
Airway versus ventilation problem? Iatrogenic pneumothorax or tension pneumothorax?

15 Primary Survey Assess for organ perfusion Circulation
(including hemorrhage control) Level of consciousness Skin color and temperature Pulse rate and character Assess for organ perfusion

16 Primary Survey Pitfalls Circulatory Management Control hemorrhage
Restore volume Reassess patient Elderly Children Athletes Medications

17 Primary Survey Caution Disability Baseline neurologic evaluation
Glasgow Coma Scale score Pupillary response Observe for neurologic deterioration

18 Primary Survey Caution Pitfalls Exposure / Environment
Completely undress the patient Prevent hypothermia Pitfalls Missed injuries

19 Resuscitation Protect and secure airway Ventilate and oxygenate
Stop the bleeding! Crystalloid / blood resuscitation Protect from hypothermia

20 Adjuncts to Primary Survey
Vital signs ECG ABGs PRIMARY SURVEY Pulse oximeter and CO2 Urinary output Urinary / gastric catheters unless contraindicated

21 Adjuncts to Primary Survey
Diagnostic Tools

22 Adjuncts to Primary Survey
Diagnostic Tools FAST DPL

23 Adjuncts to Primary Survey
Consider Early Transfer Use time before transfer for resuscitation Do not delay transfer for diagnostic tests

24 The complete history and physical examination
Secondary Survey What is the secondary survey? The complete history and physical examination

25 Secondary Survey When do I start the secondary survey? After
Primary survey is completed ABCDEs are reassessed Vital functions are returning to normal

26 Secondary Survey History Physical exam: Head to toe
Components of the secondary survey History Physical exam: Head to toe Complete neurologic exam Special diagnostic tests Reevaluation

27 Secondary Survey Allergies Medications Past illnesses / Pregnancy
History Allergies Medications Past illnesses / Pregnancy Last meal Events / Environment / Mechanism

28 Secondary Survey Mechanisms of Injury

29 Secondary Survey Pitfalls Head External exam Scalp palpation
Comprehensive eye and ear exam Include visual acuity Pitfalls Unconsciousness Periorbital edema Occluded auditory canal

30 Secondary Survey Bony crepitus Deformity Malocclusion Pitfalls
Maxillofacial Pitfalls Bony crepitus Deformity Malocclusion Potential airway obstruction Cribriform plate fracture Frequently missed

31 Secondary Survey Neck (Soft Tissues) Pitfalls
Mechanism: Blunt versus penetrating Symptoms: Airway obstruction, hoarseness Findings: Crepitus, hematoma, stridor, bruit Pitfalls Delayed signs and symptoms Progressive airway obstruction Occult injuries

32 Secondary Survey Chest Inspect Palpate Percuss Auscultate X-rays

33 Secondary Survey Pitfalls Abdomen Inspect / Auscultate
Palpate / Percuss Reevaluate Special studies Pitfalls Hollow viscus injury Retroperitoneal injury

34 Secondary Survey Rectum Vagina Pitfalls Perineum
Contusions, hematomas, lacerations, urethral blood Rectum Sphincter tone, high-riding prostate, pelvic fracture, rectal wall integrity, blood Pitfalls Vagina Urethral injury Pregnancy Blood, lacerations

35 Secondary Survey Pitfalls Pelvis Pain on palpation Leg length unequal
Instability X-rays as needed Pitfalls Excessive pelvic manipulation Underestimating pelvic blood loss

36 Secondary Survey Extremities Contusion, deformity Pain Perfusion
Peripheral neurovascular status X-rays as needed

37 Secondary Survey Pitfalls Musculoskeletal System Potential blood loss
Missed fractures Soft tissue or ligamentous injury Compartment syndrome

38 Secondary Survey Neurologic: Brain GCS Pupil size and reaction
Lateralizing signs Frequent reevaluation Prevent secondary brain injury Early neurological consult

39 Secondary Survey Pitfalls Neurologic: Spinal Assessment Whole spine
Tenderness and swelling Complete motor and sensory exams Reflexes Imaging studies Pitfalls Altered sensorium Inability to cooperate with clinical exam

40 Secondary Survey Conduct an in-depth evaluation of the patient’s spine and spinal cord Neurologic: Spine and Spinal Cord Early neurological / orthopedic consult

41 Secondary Survey Pitfalls Neurologic Incomplete immobilization
Neurologic deterioration

42 Adjuncts to Secondary Survey
Special Diagnostic Tests as Indicated Pitfalls Patient deterioration Delay of transfer Deterioration during transfer Poor communication

43 How do I minimize missed injuries?
High index of suspicion Frequent reevaluation and monitoring

44 Pain Management Relief of pain / anxiety as appropriate
Administer intravenously Careful monitoring is essential

45 Transfer to Definitive Care
Which patients do I transfer to a higher level of care? Those whose injuries exceed institutional capabilities: Multisystem or complex injuries Patients with comorbidity or age extremes

46 Summary

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