Evaluation of Trauma Patients: ABCs & Primary Survey by Dr. Mahmoud Shehadah Al-hariri

1. ABCs Evaluation of Trauma Patient 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. Airway and C-spine control Assessment • Ascertain patency • Immobilization of C-spine ; hard collar sand bags tape

5. A & C Management • Chin lift Vs jaw thrust • Clear the airway of foreign bodies • Oropharyngeal or nasopharyngeal airways • 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; NeedleCricothyroidotomy

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

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

24. B

25. End-tidal CO2 Qualitative Quantitative

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

27. Flail chest

28. Flail chest Management • Stabilization • Observation • Mechanical ventilation

30. Pneumothorax

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

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

33. C ; compession

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

35. Classes of Shock

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

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

38. Exposure • Completely undress the patient • Prevent hypothermia

39. Revised trauma score

40. تعليمات الوقاية من الكزاز

45. THANKS…..

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. Dr. Muayad Kadhim د. مؤيد كاظم