Assessment of the multiply injured patient o'connor
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Transcript of Assessment of the multiply injured patient o'connor
Assessment of the Assessment of the MultiplyMultiply Injured Injured
PatientPatientDr. Michael O’ConnorDr. Michael O’ConnorProfessor, Dept. of Emergency Professor, Dept. of Emergency Medicine, Queen’s University, Medicine, Queen’s University, CANADACANADA
The ATLS ProgramThe ATLS Program““Advanced Trauma Life Support”Advanced Trauma Life Support”
Originated in the USA- ~1980-Originated in the USA- ~1980-Trauma- “The Neglected Disease of Trauma- “The Neglected Disease of Modern Society”Modern Society”
Intended for the Primary Care Intended for the Primary Care PhysicianPhysician
Addressing early Assessment and Addressing early Assessment and RecognitionRecognition
Standardized in 32 countries Standardized in 32 countries
Regrettably, War and Conflict Regrettably, War and Conflict have consistently lead to have consistently lead to improved care of the Injured.improved care of the Injured.
Death Following TraumaDeath Following Trauma
0%
5%
10%
15%
20%
25%
30%
35%
40%
< 30 min. Hours Days-Weeks
The Stages…..The Stages….. Preparation- Prior to HospitalPreparation- Prior to Hospital Primary SurveyPrimary Survey ResuscitationResuscitation
Preparation - Prior to HospitalPreparation - Prior to Hospital
Vital SignsVital SignsPulse and Blood PressurePulse and Blood Pressure
Level of ConsciousnessLevel of Consciousness
Glasgow Coma ScaleGlasgow Coma Scale MotorMotor VerbalVerbal Eyes OpeningEyes Opening
MechanismMechanismHigh VelocityHigh Velocity
Outside conditions Outside conditions (cold)(cold)
Patient FactorsPatient Factors AgeAge Medical conditionMedical condition PregnancyPregnancy
Primary SurveyPrimary Survey
A- A- AAirway maintenance (C-spine)irway maintenance (C-spine)
B-B- BBreathing and Ventilationreathing and Ventilation
C-C- CCirculation and Hemorrhage Controlirculation and Hemorrhage Control
D- D- DDisability- Neurological Statusisability- Neurological Status
E-E- EExposure, Environmental Control xposure, Environmental Control
AIRWAYAIRWAY Relieve Airway Relieve Airway
ObstructionObstruction Head Injury, Blood, Teeth, Head Injury, Blood, Teeth,
Vomitus Vomitus
OxygenationOxygenation
Simple Airway Simple Airway maneuversmaneuvers
BREATHINGBREATHING Look ForLook For……
Equal Rise and Fall of the ChestEqual Rise and Fall of the Chest
ListenListen For...For... Air entry on both sides of chestAir entry on both sides of chest
Feel For…Feel For… Rib Fractures (Elderly Patient)Rib Fractures (Elderly Patient) Subcutaneous emphysemaSubcutaneous emphysema
Continuous Pulse Oximeter to monitor oxygenContinuous Pulse Oximeter to monitor oxygen
CIRCULATIONCIRCULATIONSHOCKSHOCK
Hemorrhage most common, Hemorrhage most common, notnot isolated isolated Brain Injury- expect Brain Injury- expect Tachycardia and Tachycardia and Cutaneous VasoconstrictionCutaneous Vasoconstriction
Other Causes-Other Causes- Cardiac- Direct InjuryCardiac- Direct Injury Tension PneumothoraxTension Pneumothorax Neurogenic- Spinal Cord InjuryNeurogenic- Spinal Cord Injury
DISABILITYDISABILITY
Neurological Neurological ExaminationExamination
EXPOSUREEXPOSURE
Undress the PatientUndress the Patient
Prevent Prevent HypothermiaHypothermia
Elderly PatientElderly Patient
Conditions that correlate with Conditions that correlate with High Mortality:High Mortality:
Head TraumaHead Trauma ShockShock HypoxiaHypoxia Sepsis-Multisystem Organ FailureSepsis-Multisystem Organ Failure Prolonged ventilationProlonged ventilation
Specific Organ Specific Organ SystemsSystems
Head InjuryHead Injury High primary Mortality, Poor functional High primary Mortality, Poor functional
outcome post discharge.outcome post discharge. High predisposition to subdural with High predisposition to subdural with
subtle presentation-- (subtle presentation-- (CT Scans)CT Scans) Airway, Cautious hyperventilation, Airway, Cautious hyperventilation,
Definitive care and decisions Definitive care and decisions
Specific Organ SystemsSpecific Organ Systems
Chest InjuriesChest Injuries
Rib and Sternal InjuriesRib and Sternal InjuriesFlail segment, Flail segment, splinting, hypoventilation and pneumoniasplinting, hypoventilation and pneumonia
Chest compliance & pulmonary reserveChest compliance & pulmonary reserve Cardiac Arrhythmia- Premorbid vs ? Direct Cardiac Arrhythmia- Premorbid vs ? Direct
injuryinjury
SUMMARYSUMMARY
Anticipate the ProblemAnticipate the Problem Primary SurveyPrimary Survey Resuscitation PhaseResuscitation Phase Know when to ask for AssistanceKnow when to ask for Assistance Elderly patients pose special Elderly patients pose special
problemsproblems