1. By Dr. Mahmoud Shehadah Al hariri Emergency Medicine Orthopedic surgery

2. Primary Survey Airway & C -spine Breathing Circulation Exposure Disability

3. Secondary Survey Mechanism of the injury Systemic evaluation Definitive treatment

4. A irway and C -spine control Assessment l Ascertain patency l Immobilization of C-spine ; hard collar sand bags tape

5. A & C Management l Chin lift Vs jaw thrust l Clear the airway of foreign bodies l Oropharyngeal or nasopharyngeal airways l Definitive airway ( intubation, LMV, Cricothyroidotomy…..)

6. Collar application

7. A & C ;patency

8. A & C ;FB

9. A & C ;airways

10. A & C NASO ORO

11. ; A & C ; Laryngeal mask

17. A & C;Tracheal Intubation

18. A & C; Surgical Cricothyroidotomy

20. A & C; Needle Cricothyroidotomy

22. Breathing Assessment l Expose the neck and chest l Rate and depth of respiration l Inspect and palpate the neck and chest l Percuss the chest l Osculate the chest bilaterally

23. B Management l Administer high concentrations oxygen l Ventilate with a bag-valve-mask or face-mask l Attach an end-tidal CO2 and pulse oximetery Attention to; l Alleviate tension pneumothorax l Seal open pneumothorax l Flail chest

24. B

25. End-tidal CO 2 Qualitative Quantitative

26. Haemothorax Management Chest tube Indication of surgery 1500 ml once 200 ml/h

27. Flail chest

28. Management Stabilization Observation Mechanical ventilation

30. Pneumothorax

31. Management Simple ; observe Tension ; needle insertion chest tube 3-side patch (for 0pen,sucking)

32. Circulation Assessment Pulse: presence, quality, rate, regularity, paradox l Identify source of external hemorrhage l Skin color ( extremities ) l Blood pressure ( shock )

33. C ; compession

34. C Management l Direct pressure to external bleeding site l Insert two large-caliber intravenous catheters l Obtain blood for Labs; Hct, cross-match and ABGs l Start rapid IV fluid ( RL, NS ) l Pneumatic splints or PASG to control hemorrhage l ECG monitor

35. Classes of Shock

36. Traumatic Types of Shock Hypovolemic ( low CVP ) Cardiogenic ( high CVP ) Neurogenic ( low HR )

37. Disability Assessment l Determine the level of consciousness using AVPU l Assess the pupils for size, equality and reaction

38. Exposure l Completely undress the patient l Prevent hypothermia

39. Revised trauma score Respiratory rate Systolic pressure GlasgowNumber 10 - 29> 8913 -154 > 2976 - 899 - 123 6 - 950 - 756 - 82 1 - 51 - 494 - 51 0030

40. تعليمات الوقاية من الكزاز نمط الجرح التمنيع غير معروف < 3 جرعات < 5 سنة من اخر لقاح 5-10 سنة > 10 سنة نظيف صغير ذيفان الكزازلا شيئ ذوفان الكزاز باقي الجروح غلوبولين مناعي + ذوفان الكزاز لا شيئذوفان الكزاز

46. MoKazem.com هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali. This site is not responsible of any mistake may exist in this lecture. د. مؤيد كاظمDr. Muayad Kadhim