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Critically injured patient

Critically injured patient. Prof Mohan de Silva. Essential words to remember. TRIMODAL distribution of deaths ATLS Primary survey Secondary survey. The Critically Injured. Trauma commonest cause of hospital admissions in Sri Lanka since 1995

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Critically injured patient

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  1. Critically injured patient Prof Mohan de Silva

  2. Essential words to remember • TRIMODAL distribution of deaths • ATLS • Primary survey • Secondary survey

  3. The Critically Injured Trauma • commonest cause of hospital admissions in Sri Lanka since 1995 • commonest cause of death below the age of 40 in many countries

  4. The critically injured • Majority died due to inadequate treatment • Initial treatment determines the outcome • Early intervention is essential

  5. GOLDEN HOUR OF TRAUMA

  6. TRIMODAL DISTRIBUTION OF DEATHS • Immediate • 1st few hours • Few days after admission

  7. Conventional approach • History • Examination • Investigations • Diagnosis • Treatment

  8. How it all startedAnother accident ………..

  9. New approach… A T L S • Initial assessment ( History, Examination ) Resuscitation ( Treatment ) WILL BEGIN SIMALTANEOUSLY • Recognize and treat the most life threatening injury first

  10. TRAUMA KILLS ACCORDING TO A SEQUENCE ! • Acute airway obstruction - The quickest killer • Inadequate breathing • Hypovolaemia • Expanding intra cranial haematoma

  11. Hypoxia and Hypovolaemia are the main killers • Hypoxia kills before hypovolaemia

  12. PRIMARY SURVEY • SECONDARY SURVEY

  13. Initialassessment and resuscitation Primary survey • Air way with cervical spine control • Breathing • C irculation • Disability (Neurological ) • Exposure • Foleys catheter

  14. Airway obstruction recognition and treatment • Identify – SPEAK TO THE PATIENT • establish OXYGEN • protect OXYGEN • maintain OXYGEN 10 L / minute

  15. Immobilisation of the C spine • sand bag • collar • tape

  16. B reathing • Inspection - wall movements,ext. injuries etc • Palpation - cripitus • percussion - hyperesonence or stony dullness • Auscultation - breath sounds absent RESPIRATORY RATE

  17. Circulation All critically injured patients are in hypovolaemic shockAction PULSE RATE , B P • 2 Big drips to Two big veins • 2 L of N Saline fast in • Blood cross matching

  18. D isability (Neurological ) • A V P U • Glasgow coma score • Expose the patient Where is the scissor !

  19. Secondary survey Pulse - BP – RR -Temperature • Systematic examination from head to toe • LOG ROLL • Finger to all orifices • Minor injuries

  20. HistoryA M P L E • A llergies • M edications • P ast illnesses • L ast meal • E vents leading to the injury

  21. Outcome • ? • ? • ?

  22. TAKE HOME MESSAGE • What is the first thing you do when you get a critically injured ? • What is the quickest killer of the injured? • What is trimodal distribution of deaths? • What is the difference between conventional and ATLS approach • What do you do in Primary and secondary surveys?

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