of Multiple Injuried Patient Bailey amp Loves Short Practice of Surgery 27th EditionCh 23Early assessment and management of severe trauma Browses Introduction to The Symptoms and Signs of Surgical ID: 929860
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Slide1
Slide2History & Examination of : Multiple Injuried Patient .
Bailey & Love's Short Practice of Surgery, 27th
Edition.Ch
(23),Early assessment and management of severe trauma .
Browse’s Introduction to The Symptoms and Signs of Surgical
Disease.Ch
(2) The symptoms, signs and emergency management of major injuries.
Slide3Trauma
It implies that a physical force exerted on a person has led to a physical injury. External energy forms and forces that can lead to injury include chemical, thermal, ionising radiation and, most frequently, those of mechanical origin. The degree and severity of trauma sustained can vary substantially and depend upon the magnitude of force exerted.
Slide4History at the scene of accident
Place.Time.Nature of the accident.Mechanism.Injury & associated symptoms.
Consciousness level .
Period of rescue .
Slide5History during ambulation.
Type of transport.Resuscitation.Consciousness level .General status.Period.
Associated symptoms.
Management during ambulation.
Slide6History at arrival to hospital.
General status at arrival .Consciousness level .Management a E & A department.General status after management.Discharge / Transferred to the theater or was admitted to the surgical ward.
Slide7Types of Trauma.
Blunt injury.Penetrated injury.Superficial .Deep.
Mono-injury / Poly injury.
Slide8Triage
Classification of injured patients.
Slide9Slide10Slide11Slide12Advanced Trauma Life Support ( A.T.L.S. ) Protocol .
Primary survey follows cABCDE.
Slide13c: Exsanguinating external
haemorrhage.A: Airway with cervical spine controlB: Breathing and ventilation.C: Circulation and haemorrhage
.
D: Disability (G.C.S. & neurological status) .
E: Exposure (assess for other injuries) .
Fracture.
Slide14Glasgow Coma Scale (G.C.S.)
& Cushing’s triad
Slide15Slide16Cushing’s triad
Slide17Clinical signs of hemorrhagic shock.
Tachycardia.Hypotension.Pallor.Oliguria.Cold extremities.
Acidosis.
Tachypnea.
Change in mental status.
Slide18Slide19Slide20Clinical signs of
- Hemothorax. - Pneumothorax .
- Pericardial tamponade.
Slide21Hemothorax
Dyspnea.Ipsilateral chest movement limitation.Trachea is deviated to the contralateral side.
Deviation of apex beat .
Reduced breath sounds .
Dull percussion note.
Reduced vocal fremitus .
Reduced vocal resonance.
Unilateral / Bilateral
Slide22Slide23Pneumothorax
Unilateral / Bilateral
Dyspnea.
Ipsilateral chest movement limitation.
Trachea is deviated to the contralateral side.
Deviation of apex beat .
Reduced breath sounds
Dull percussion note
Reduced vocal fremitus .
Reduced vocal resonance.
Slide24Slide25Pericardial tamponade
This reduces the cardiac output, producing : Weak pulse Hypotension.
(
Kussmaul’s
sign) : The jugular venous pressure is markedly elevated and rises rather than falls with inspiration however, jugular venous distention may not occur in a patient who has lost a large quantity of blood.
Pulsus
paradoxus
, ( pulse volume decreases on inspiration rather than increasing ).
Muffled heart sounds and poorly heard.
Slide26Slide27Secondary survey.
All severely injured patients require a detailed top to toe examination after life-threatening injuries have been identified and managed during the primary survey.
Slide28Focused Abdominal Sonography for Trauma
Or “Focused Assessment with Sonography for Trauma”. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients, in three potential body spaces, namely, pericardial, pleural and peritoneal spaces. The four target areas of scanning include the pericardial view, right upper quadrant (RUQ) view, left upper quadrant (LUQ) view and pelvic view.
Free fluid in the peritoneal space may be referred to blood / bowel content and urine ( intraperitoneal urinary bladder injury ).
Slide29Slide30https://www.youtube.com/watch?v=Yg78aU93SZE
Slide31Diagnostic peritoneal lavage ( D.P.L.)
This procedure is performed when intra-abdominal bleeding (hemoperitoneum ), usually secondary to trauma, is suspected.A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1
litre
of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.
100,000 RBCs/mm
3
.
500 WBCs/mm
3
.
Slide32https://www.youtube.com/watch?v=O9BZamRlXVA
Slide33Peritoneal aspirate ( P.A.) .
With aid of F.A.S.T., peritoneal aspirate can be applied to identify the intraperitoneal fluid .
Slide34Slide35Damage Control Surgery
Is an operative technique in which control of bleeding and stabilization of vital signs becomes the only priority in salvaging the patient. This usually occurs during laparotomy when there is significant bleeding in the abdomen. Attention is directed at using all available techniques for controlling bleeding, including packing. Definitive repair of bowel or visceral injuries in not attempted and temporary wound closure is used. Definitive procedures are performed after the patient has stabilized.
Slide36تم بتوفيق الله