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Initial Management of Trauma |
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Concepts of initial management: ¨ Rapid primary survey ¨ Resuscitation ¨ Adjuncts to primary survey / resuscitation ¨ Detailed secondary survey ¨ Adjuncts to secondary survey ¨ Re-evaluation ¨ Definitive care
Primary survey and resuscitation of vital functions are done simultaneously—a team approach. This involves A,B, C. The airway needs to be secured and it cannot be assumed that an airway will remain ok.
Adults/ paediatric / pregnant women—priorities are the same. A Airway with C-spine protection B Breathing C Circulation D Disability E Exposure / environment
Resuscitation ¨ Protect and secure airway ¨ Ventilate and oxygenate—100% oxygen and 12l/min ¨ Stop the bleeding! ¨ Vigorous shock therapy—fluid 2l crystalloid / saline ¨ Protect from hyperthermia—warm to 39 C
Special consideration—Trauma in the Elderly ¨ 5th leading cause of death ¨ Physiological reserve—compensation reduced ¨ Co-morbidities: Disease / medications ¨ Outcome depends on early, aggressive care
Breathing ¨ Assess— look at the chest ¨ Oxygenate ¨ Ventilate ¨ Caution—pneumothorax, tension pneumothorax
Assessment of Organ perfusion ¨ Level of consciousness ¨ Skin colour and temperature ¨ Pulse rate and character
Circulatory Management: ¨ Control haemorrhage ¨ Restore volume ¨ Reassess
Disability ¨ Baseline neurological evaluation ¨ GCS scoring ¨ Pupillary response—equal and reactive? ¨ Caution sign: observe for neurological deterioration
Adjuncts to Primary Survey ¨ Chest and pelvic x-rays ¨ Diagnostic Peritoneal Lavage ¨ Ultrasound ¨ Arterial Blood gases ¨ Pulse oximeter and CO2 sats ¨ Urinary / gastric catheters unless contraindicated– monitor urine output ¨ ECG ¨ Do not delay transfer for diagnostic tests ¨ Use time before transfer for resuscitation
Re-evaluation—proceed to secondary survey after: ¨ Primary survey completed ¨ ABCDEs are reassessed ¨ Vital functions are returning to normal
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