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Overview of Trauma

Overview of Trauma. Maggie Gordon R2 July 9, 2007. Initial Assessment and Management. Primary survey and resuscitation Adjuncts to 1 ° survey Secondary survey Adjuncts to 2° survey Definitive Care. Walk into room. Orders Monitors O 2 IV r/o tension pneumothorax.

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Overview of Trauma

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  1. Overview of Trauma Maggie Gordon R2 July 9, 2007

  2. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  3. Walk into room • Orders • Monitors • O2 • IV • r/o tension pneumothorax

  4. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  5. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  6. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  7. Airway with C-spine Protection • Endotracheal tube purposes: • Airway • O2 • Ventilation • Prevent aspiration

  8. Airway with C-spine Protection • Need airway protection: • Decreased LOC, including agitated • Face, neck trauma • Aspiration risk – bleeding, vomiting • Need ventilation • Apnea • Inadequate respiration • Head injury requiring hyperventilation

  9. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  10. Breathing • Auscultation • Percussion • Diagnose and treat • Tension pneumothorax • Massive hemothorax

  11. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  12. Circulation • Diagnose and treat massive bleeding from / into: • Chest • Abdomen • Pelvis • Long bones • IV access, fluids

  13. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  14. Disability • Quick neuro exam • GCS • Pupils • Glasgow Coma Scale

  15. Primary Survey and Resuscitation • Airway with C-spine protection • Breathing • Circulation • Disability • Exposure, Environment

  16. Exposure, Environment • Cut off clothing • Keep patient warm • Warm IV fluids • Warm flannels • Bear huggers

  17. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  18. Adjuncts to Primary Survey • Monitoring • Sats • BP • Blood-work – “trauma panel” • End-tidal CO2 • ECG • ABG • Foley (quick rectal first), NGT • X-rays, diagnostic studies • Chest, pelvis, C-spine • FAST / DPL

  19. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  20. Secondary Survey • Head and skull • Maxillofacial and intra-oral • Neck • Chest • Abdomen • Back • Perineum, rectum, vagina • MSK • Neuro

  21. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  22. Adjuncts to Secondary Survey • CT • Contrast X-rays • Extremity X-rays • Endoscopy • US

  23. Initial Assessment and Management • Primary survey and resuscitation • Adjuncts to 1° survey • Secondary survey • Adjuncts to 2° survey • Definitive Care

  24. Definitive Care • Consults • Transfer

  25. Cases

  26. Case 1 • 26 y.o. F. MVA at 60km/h, hit a brick wall while swerving. Wearing seatbelt. Airbags deployed. No  LOC. In C-collar, on spine board. • Healthy, no allergies, only med is BCP

  27. Case 2 • 18 y.o. M. Unbelted, thrown from convertible when it rolled. Brought by helicopter in C-collar and on spine board. GCS 3 the entire time. Intubated on the scene. BP 145/75, HR 50, sats 99%.

  28. Case 3 • 52 y.o. M. Driving motorcycle, struck by SUV. In C-collar, on spine board. Helmet removed by EMS at scene. GCS 14 entire time. • Healthy, no allergies, no medications • HR 120, BP 95/55, RR 18, sats 100%

  29. Case 4 • 26 y.o. M. Shot in abdomen. GCS 14 entire time. • Healthy, no allergies, no medications • HR 120, BP 95/55, RR 18, sats 100%

  30. Case 5 (ER Case) • You are driving along Lakshore Blvd. You witness a 30 y.o. F bicyclist struck by car. • Very anxious, respiratory distress, no obvious blood, L femur deformed.

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