1. An Introduction Year 4 Tutorials
Trauma
An Introduction
Year 4 Tutorials

2. HOW TO ASSESS THE TRAUMA PATIENT?
PRIMARY SURVEY
SECONDARY SURVEY

3. 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

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

5. 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

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

7. 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?

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

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

10. 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

11. PREDICTING INJURIES

12. History / Scene Assessment

13. 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

14. 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

15. Questions ?