NUTRITION

unrmmunm

ASSESSMENT
mmmm mm OF
err
NUTRITION
mmmm

1 Midarm circumference
2 Triceps Skin Foldthickness
3 Body Mass index
4 SrAlbumin Best of all methods in surgical patientsI

MILENIETITEHEEKEESEESEEEEEKEE 00hm
THE MOSTTOOL Clinical assessment tool of malnutrition
Basedon 3 Factors

BMI wtloss in 3 6Months Acute DiseaseEffect

0 720 0 251 Add a score of 2
i 18.5 20 12 i 5 Iot iF thereis reducedintake
75 days
18.5 lot
Indications forArtificial
ummm
Nutrition
murmur on ummm

Any patients whohassustained 7 days of inadequate intake

Any patients who is anticipated tohave no intake for 7days
TYPES OF NUTRITION

ENTERAL NUTRITION PARENTERAL NUTRITION

Nutrition given via G1 Tract Nutritiongiven via veins
k v
1 SipFeeding 1 Peripheral Parenteral
2 Tubefeeding 2 Central Parenteral
i Nasogastrictube Ryletube 3 Peripherally Inserted
ii Naso jejunal tube Central catheter
iii Feeding Gastrostomy CHICKMANN
iv Feeding Jejunostomy
V PEG Tube

ENTERAL
mmmm
NUTRITION
mmmm
NASOGASTRIC FEEDING
We use Ryle'sTube 110 130cmtube
Ideal Length
NEXRule NoseEar Xiphisternum inadults RYLES TUBE
MENURule NoseEar MidpointofEpigastriumtoUmblicus
 Howto insert a Ryle'sTube Bysitting with neckflexed
FOWLER'S POSITION
out
Howto confirmthe tip is inthe stomach r bellofstethoscope
I Auscultate in the epigastrium with Stethoscope bysimultaneously
pushing air in an empty syringe throughtheexternal portoftube

I Aspiration ofsecretions testwith LitmuspaperforpH Idealtest

II LookforReflux of Gastric contentintube
II XRay

ummm for
Indications shifting to NASO JEJUNAL TUBE
unnummmm mm
fREKA'STUBE
k k
1 Duodenal Fistula need a Interventional Radiologist
2 AcutePancreatitis MedicalGastroenterologist
Nottoleratingto NGTube Invasive Procedure

Maximumtime we canuse NasalTubes for 4weeks only

If youwant togive 4weeks

4 6 wks nutrition for 6weeks

v f
PEGTube FEEDING GASTROSTOMY
Techniques
ummm Endoscope
f FEEDING JEJUNOSTOMY
prefferedin coma Pt
1 Pull Through FG causesAspiration

Is Iii
DIRECTSTAB

ee
WITZEL
2 DirectStab Techniques
TTUNNELING
to
TECHNIQUE

COMPLICATIONS OF ENTERAL NUTRITION

mummmurn m ummm mmmm

1 Tube Related Complication CMC

Malposition Obstruction
Leakage
2 Osmotic Diarrhea
3 Electrolyte imbalance lessthanParenteral
4 Refeeding Syndrome
PEG TUBE
RhmEEE
In case of mass casuality Categorisingthe
patients to betransffered to hospitals
according totheseverity of injury is
known as Triage
Done Paramedicalteam
Traiageis afrench word means tosort
4Colourcodes aregiven
RED Immediate management required Gin minutes
Eg TENSIONPNEUMOTHORAX PERICARDIALTAMPONADE
YELLOW to bemanaged within 2hrs
Eg MAJORBONEFRACTURE OPEN PNEUMOTHORAX
GREEN to be managed after 2hrs ambulancetransfernotneeded
Eg TIBIALFRACTURES WRISTBONEFRACTURES
BLACK dead or about to diepatients
MULTIPLE CASUALITY Enoughresourcesavailable to
Triage is donefor managethe patients
MASSCASUALTY Enoughresources are notavailable
tomanagethe Patientscoming
to casuality

PRIMARY
ummm SURVEY
ummm
Control of Exanguinating Hemorrhage
A
c i stop majorvesselbleeding
Airway by pressure or torniguet
B Breathing
c circulation
D Disability
F Exposure

AIRWAY
mmmm

Best way to accessthe airway make ptspeaks

k
if hetalksfluently
4
PATENTAIRWAY
Intubation ofthept done when GCSscore 58
 Manoeuvres doneto stabilise the Patient
I Apply a Hardcervical Collor
II Put him on a HardBoard
MCCofairway obstruction in TraumaPt TOUNGEFALLINGBACK
Manoeuvres to prevent this
I JAWTHRUST
It CHINLIFT
Extension ofneckshouldnot bedone
II GUEDELAIRWAY
INTUBATIONS

OROTRACHEAL NASOTRACHEAL
MCdone Contraindicated
CII Maxillofacial
ummm
for 1time
mm mm
v Baseofskull
v cribriformPlate
v V CSFRhinorrhea
do TRACHEOSTOMY V Maxillofacial

TRACHEOSTOMY

EMERGENCY ELECTIVE
NEEDLE TRACHEOSTOMY TRACHEOSTOMY
aka CRICOTHYROIDOTOMY k
k Doneat 2ndBrd TrachealRing
Identify thyroid membrane
crico
Avascularmembrane
I
Puta widebone needle IGG
Cor
3mm14mmcatheter
k
flow02Maxfor42hour
Through it givehigh

CII For children

www
512yrs
I
candevelopstenosis
LEMON
ummm
Assessment
mmmm

L Look Externally

E Evaluate 3 3 2 Rule
H 2fingerdistance b w
3fingersenter 3fingerdistance bw
mouth Hyoidbonetochin Thyroidnotchtofloorofmouth
 M Malampatti Classification is difficulttointubate
hrard
Examinefor softpalate UVULA CLASSII only palateseen
0 Lookfor Obstruction
N Lookfor Neck Tenderness
Neck mobility

BREATHING
ummm ummm

Look for Tension Pneumothorax

Flail chest
CIRCULATION
mnmnnnnmn
measured by BP if BP 10W
I
Lookfor BLEEDINGSITES
ONE ON FLOOR FOUR MORE
vCheck
ClosedFitsizeClotonFloor 350mi Abdominalcavity
Pad fullysoaked 500Mt Chest 12L blood
Pelvic 2L blood
LongBone 1L blood
Management
mm mum

Twoshort WideBore Cannula

GREEN

Ifmum
veinnot
available
un mum
CUT DOWN Saphenous vein
for
v INTERNALJUGLARVEIN
Forchildren CGyrsold INTAOSSEOUS TRANSFUSION
Infuse 1L of 7.51 Hypertonicsaline
Maintain PERMISSIBLE HYPOTENSION 70 00mmHg SBPmaintained
Iv
i.e if 13PM if BP k
k k
Rebleeding cerebralhypoxia
CRASH 2 Trial
if SBP590mmHg PR 71101min
k
onthespotgive Igm Hj TRANEXAMICACID STAT
Igm 8hourscontinous infusion
SECONDARY
mummmunn SURVEY
ummm
Detailed examination of Patient
WBCT wholeBodyCTscan 76 X Ray Chest
 Detailed Report in 45minutes

LOGROLLEXAMINATION
doneby 4 people
Rotate Pt on oneside by 3 people
Iwillexaminethespine
Meantfor SPINEEXAMINATION PRIMARLY
other i PIRExamination
ii And winkReflex
iii VERMOOTEN SIGN to lookfor Floating Prostate in
Membranous urethra injury CCIInow
Not done now
absolutely CII in Pelvic Fractures

In Secondary Survey AMPLE history

A Allergy history
M Medical history
p pregnancy1Presentillnesshistory
L Lastmeal
E Explain the mechanismofinjury

If any cervicaltenderness X RayCervicalSpine

x
AP Lateralviewtaken
1
doneaccording to NEXUSCriteria CanadianC SpineRule
SCORINGSYSTEMS

ISS RTS TRISS MESS

E Tie
RespiratoryRate
seeBP
R RTsscore
I InjurySeverityScore
Mangledextremity severity
Score
S Gcs seenage M Mainenergythat
g specificmechanism causedinjury
BLUNT PENETRATING E ExtremityIschemia
s seenage
5 Shock
ALESeale CEEBEEILAIEEIIEEEYSCA.LI
Represented as 1 2 34 5 6 7 Grade ofinjury
L k v v
Regionofinjury Typeof SpecificAnatomical Levelofinjury
Anatomical Structure
Structure
 NS
thunn D Regions
1 Head 6 spine
2 Face 7 Upperlimb
3 Neck 8 Lowerlimb
4 Thorax 9 BURNS
5 Abdomen

DAMAGE
mmmm
CONTROL
mmmm
SURGERY
mmmm

Indications i Hypothermia
ii Acidosis DEADLYTRIAD OFTRAUMA
iii Coagulopathy
iv Sr Lactate 75mmol11
v ISS 736
Yi SBP 570mmHg
vii Transfusion 15units

EARLY TRAUMACARE ETC

Definitive management inTrauma pt
Within 36hr5 ETC done ifthereisnoneoftheabovefeaturesseen
SRLACTATE

ifit's 52mmol1L ifit's 25mmol1L ifit's 75mmol11

Iv Iv Iv
do ETC Manage it in ICU do DCS
PHASES OF DAMAGE CONTROLSURGERY

PHASE I PHASE I PHASE II

Initial Exploration Secondary Resuscitation Definitive treatment
K K t
happens Emergency 0T happens ICU happens Elective OT
k k k
Openthe abdomen keepthe Pt upto48hrs after 48hours
Full Laprotomydone Iv Iv
Don'tdodefinitive t Mange Acidosis dodefinitive Ht
Aim i Tostop bleeding Hypothermia y
ii To stop contamination Coagalopathy ClosetheAbdomennow
Sheetsused Indianmethod BagottaBag
keeptheabdomen
sheetoveropener
OPSITE
Placea it VAC devices
 STAGES
ummm OF
u DCS
un Asper Bailey Love
STAGE I Selection of patient

STAGE I Phase I Emergency 0T Stopbleeding contamination

STAGE II Phase I ICUManagement

STAGE II Phase II Elective 0T Definitive t.lt

STAGE I Closetheabdomen

HEAD
hmm INJURY
mmmm

Normal Cerebral Blood Flow 55hr11min

Ishemia happenswhen 525m11min
Cerebral Perfusion Pressure CPP 75 105mmHg
urn
µ
MAP ICP
90110 5 15
MUNRO
mmmm KELLIE
mmmm
DOCTRINE
mmmm

Skull is a closed compartment atanypoint of 3components are constant

in it They are Brain
CSF
Blood
If one component is compressedorincreasedthe othercomponentwill
compensate

if there is hematomaon oneside

It willcause
1 Midlineshift
2 Cingulate gyrus herniation
3 Herniation ofuncus of
Temporallobe
4 Brainstem Herniation
5 Cerebellum Herniation

Herniation ofuncus of Temporallobe

4
Pupillary Abnormalities At OCULOMOTORNERVE COMPRESSION

IPSILATERAL FIXEDDIALATED PUPIL

Cerebellum Herniation CUSHING'STRIAD HTN
BRADYCARDIA
RESP IRREGULARITY
 How to prevent Brain Herniation
I byreducing CSF Id Intracranial Pressure ICP
x
1 keepthe ptin Headup position 15 300
2 Injection to ReduceICP
A MANNITOL Fluidofchoice
osmoticdiuretic
B DIURETICS Canbeused if BP isfine
3 Sedatethem
A Mj BARBITURATE
DON'TGIVE DIAZEPAM
mmmm
4
cause respiratory depression
4 FITS PROPHYLAXIS
SodiumValproate
5 Infection Prophylactic Antibiotics
STEROIDS are
mmmm CII
I
stimulate 9Stresshormones
Lumbar Puncture CII
ummm ummm
Iv
causeherniation
6 ExternalVentricular Drainage
7 NasalOxygen
Alsomaintain MEUR0INTENSIVE CAREUNIT VALUES
H
1 ICP 420mmHg
2 Cpp 360 70mmHg
3 MAP 700mmHg
4 Pack 80 100mmHg 1012kpa
5 Paca 35 45 mmHg 4 6kpa
Bestmethod to KICP EXTERNAL VENTRICULAR DRAINAGE
Sometime if Pressureistoohigh Decompressive Craniotomy

GEEESEEKEEKESCALE Gcs

EYE OPENING 4 VERBALRESPONCE 5 MOTORRESPONCEG

spontaneous 4 ONE Oriented 5 OBEY Obeyscommand O
Oncall 3 CONFUSEDI Confused 4 LOCALITIES Localise
pain 5
On pain 2 WORD Inappropriate 3 WITH withdraulontouch
4
Donot open 1 SOUNDS sounds 2 FLEXIONRigidityDecorticate 3
NOWHERENoSounds 1 EXTENSION Decerebrate 2
Now Noresponce I
 Best of above 3 Motor Responce
MaximumScore
Minimumscore 18 for adeadalso
OnIntubation verbalresponcecan't betested
k
VNT score O
i mentionedas
Intubate the pt when GCS 58
CTisscanis taken at admission when the GCS513
Iftwodifferentscores areshown with 2 limbs
t
Takethebestscores
HEADINJURY

MINOR MILD MODERATE SEVERE

GCS 15 GCS 14115 GCSD 13 GCS 3 8
NO LOC withLOC
CLINICAL
mmmm
FEATURES
mmmm

HUTCHINSON PUPIL Fixed dialated Pupil

dit oculomotor nervestretching
BLIND BURR HOLE without CT scan
K
done insideof Hutchinsonpupil
Oldendays
KERNOHANNOTCH PHENOMENON
Contralateral hemiplegia
But in thisphenomenon HUGE HEMATOMA
4
brainpushed to oppositeside
t
compressthepyramidaltract onsomesideitself

IPSILATERAL HEMIPLEGIA
CSF RHINNORRHEA AILIERLOECIALYELLEESEA
RACCOONEYES 1 BLACK PANDA Eyes I
NGtube C
NTintubation
BATTLE SIGN Bruising overmastoidprocess MIDDLE CRANIALFOSSA
CSFOTORRHEA
TEST FORCSF RHINNORRHEA Putthe CSFin a tissue paper
BLOOD Blood willoccupycenter CSF
g
zq CSF
will occupy peripheral
Beta 2 Transferrinwillbe elevated
 POSTERIORCRANIALFOSSA
Visualdisturbances
VERNETSyndrome 9 11 nerve paralysis DIE
Jugular Foramen compression
Fracture
NON
mm
CONTRAST
mmmm CT
in
NCC
mm
1 BRAIN
mm

NICE
mm
GUIDELINES
mmmm

IndicationsofCT in Ihr 1 GCS 43 at admission BATTLESIGN

2 GCS 515 at anypoint oftimeafter
2hr3
Focalneurologicaldeficit
4 Open1depressed skull
5 71 episodes of vomiting
6 Seizure
Indication ofCTwithin 8hr 1 Age 365yrs
2 Pt taking anticoagulants
3 Retrograde amnesia for 30min
4 No dangerous mechanism of injury

NCCT BRAIN

EDH SDH ICHalsoincludeSAH

Biconcaveappearance ConcavoconvexAppearance VMCType tch

I
TheyhaveLIEDinternal V NO LUCID INTERVALseen dltHTNinPUTAMEN
v mo LOCfromthe time For ICH NoSxdone
Thereis Periodof Normal of trauma
conciousness before hegoes
to Loc Reason The
hematomaisslowly
expanding
 EDH SDH ICHalsoincludeSAH
It's dit PTERION Vlt'sdlt BRIDGINGVEIN
1 DAMAGE
Middlemeningealartery t
bleeding i Locpresentattimeot
t trauma
Hematoma TYPES
Ttt Toc Burrhole
Best prognosis A ACUTESDH BCHRONICSDH
Mortality 51 SeeninTrauma peopleonanticoagulant
Ttt Craniectomy Ttt Burrhole
Evacuatehematoma
Badprognosis
Mortality 401

OTHER
ummm
INJURIES
mmmm

DIFFUSE AXONAL INJURY

Highacceleration deceleration injury
NoSxdone
Wait watch
IOC MRI
SKULL FRACTURES
Depressed Noneed to worry
Displaced Open treated surgically Antibiotics

FACE
nvm INJURIES
mmmm

MC Injury Nasal Bone Fractures

MAXILLOFACIAL
ummm mm n ILE
m
FORT
nm
INJURIES
mum

TYPE 1 TYPE 2 TYPE 3

Fracture line at Hard PyramidalShaped Craniofacialdislocation

Palate 1
CSFRhinnorrhea
 MANDIBLE FRACTURES
MCSite Neck of condyle
v
2nd Angleofmandible
v
3rd canineTooth level
I
4th Middle ofmandible

ZYGOMATIC FRACTURES
ORBITFRACTURES
Order of Injury FLOOR MEDIAL WALL LATERALWALL ROOF
Orbit bone Fracture Trapping of muscle happen
Restriction of eye movement
MC Musclegetstrappedin children INFERIOR RECTUS
10C forallaboveFractures CECT FacialBone
TOC forallaboveFractures ORIF Open Reduction InternalFixation
NECK
mum
INJURY
ummm

PENETRATING BLUNTINJURY
Highest mortality cerebrovascular Injuryseen

NECK ZONES

From angleofmandible LEASTACCSESIBLE

to baseofskull AREA

Fromcricoidcartilageto MOSTACCSESIBLE AREA

angle ofmandible HIGEST RISKOFINJURY
From thoracicinlet
to cricoid cartilage
BLUNT
ummm
CEREBROVASCULAR INJURY IN
ummm mmmm mum un
MECK DENVER'S Grading
ummm
Grade I Lumennarrowed525
Grade II Lumennarrowed725T Antithromboticdrugs Antiplatelet
Grade II i Pseudoaneursym
Grade II i Occlussion ofvessel
Grade I Transectionofvessel Need 5 1Endovascularstent immediately
THORACIC
mmmm INJURY
mmmm

DANGEROUS DOZENINJURIES

IMMEDIATELY LIFE POTENTIALLY LIFE

THREATENING THREATENING
Airway obstruction AorticInjury
Tension Pneumothorax Tracheabronchus injury
Open Pneumothorax MyocardialInjury
PericardialTamponade Diaphragm Rupture
Flail Chest Esophageal Injury
Hemothorax Pulmonary contusion

MC Injury in Thorax RIB FRACTURE

MC cause of death
a In a bluntthoracic injury Tracheobronchial hj
b In penetratingthoracic injury Hemothorax

IIEEEESIELTIRE PLACEMENT
Where will Upperborder of Rib
youput
in not lower
border there
thevessels nervesarepresent
Triangle otety where putthe ICDTube

APEX AXILLA
ANTERIORLY Postborderof PECTORALIS
Major
POSTERIORLY
by Midaxillaryline
horizontal
INFERIORLY by imaginary
linedrawnatthelevelof
nippleto meetmidaxillaryline

Bestspace toputICD 5thICS Midaxillaryline

weuse 28Fr 32Fr Butensure allholesareinside chest
ForPneumothorax ForHemothorax
ICD willbeconnected to a bag 1bottlecontaining
ummm ummm water
k
0cmH2Osuction
CBecausuemfheofaxw.FIunRdeDrRIteNIfeFsurej

v so it cansucktheairaround
2382
12 Map
lad
FunctioningICD
moving ofthe air liquidcolumn in ICD tube
incorresponcewith respiration
 Ifthe column is notmoving Implies
ICD not in position
Blocked
DisplacedICD
Lunghasfullyexpanded

ICD Tube is removed when fluidcoming is a50m11

day
Cor Lung Fullyexpanded

RemovethetubeinFullinspiration
b to 20cm H2Osuction canbe made
Usually it come withoutsuction
ifmassive amountof bloodcomingthrough ICD
if IClamptheICD Not beneficial Don'tclamp
1It'sdoesn'tgivetamponadeeffect
THORACOTOMY
mummmunn

Indications i Hemothorax 1500mi Blunttrauma

ii Hemothorax 1000mi penetratingtrauma
iii Hourly collection inICD of 200m11hr for 3hours
iv Alldangerousdozeninjuries
except PULMONARYCONTUSION
FLAILCHEST
PERICARDIAL TAMPONADE
Mc mechanism penetrating trauma
trauma to
penetrating Heart
Bloodcomes out oftheheart

Blood in Pericardialcavity
I
compresstheheart

Ctf BECK'S TRIAD Raised JVP

LowBP
Muffledheartsounds
Notachypnea seen in Tension Pneumothorax
IOC eFAST
X Ray AIR BAGAppearance
Immediately under ECHOguidance at an angleof 450toheart you
must do Pericardiocentesis Needle Pericardiocentesis
MCcomplication of Needleinsertion ARRYTHMIA
Definitive Ht Thoracotomy Repair Myocardialtissue
 TELEKI REELLUEIHORTH

ftp.t i
o
b

MC Mechanism Penetratingtrauma
Blunttrauma c Ribinjury
centralvein insertion
v
Here the pleura is intact
Damage to Lung parenchyma

Collection of air bw Parenchyma Pleura

1
Compression ofLung
k
Mediastinalshift
Absentbreathsound
t JVP
k BP
Dyspnea Tachypnea
Lifesaving
an urn procedure
mmmm

Along the midclavicularline in 2nd ICS

k Emergency Thoracocentesis
Puta wideboreneedle
ATLS 10thedi 5thICS Midaxillaryline
2ndICS Middavicularline in children
Definitive Ht ICP insertion
OPEN
mum
PNEUMOTHORAX
mum mum
SIMPLE
chestwall V Both Lung Pleura injured
Chest wall intact
Pleura e t
tf iguana setback

Ht ICD insertion
SUCKING
ummm TYPE
mm OFOPEN
mm
PNEUMOTHORAX
ummm mm

I V Opening seen in Lung Largedefect 3cm

Pleura

h i air
Chestwall

enters.infoiunonggsePnheafoenF un's

Suckingthe air

Immediate LTE 3 way FLAPVALVETYPE

CLOSURE

Definitive Ht ICD Insertion

HEMOTHORAX
nvm ummm

MC cause Intercostalartery bleeding

othervessel InternalMammary Arterybleeding
InternalThoracic artery bleeding
1stline Ht ICD Insertion
murmur
to
if 1500Mt Bluntinj
if 1000mL Penetrinj THORACOTOMY
if 200m11hr for 3hrs
RIB
un
FRACTURES
ummm
1st RibFracture Rare causesSCA injur Con
BrachialPlexusinjury
Apexoflunginjury
10 12th Rib Rare Spleen Liver injuries
4th 6th Rib While doingCPR
Management Analgesics
Noneedof stripping IsxneededforsimpleFractures
Sternal Very rare
suspect Myocardial Mj do ECJ checkmyocardial
Function
FLAIL
nvm CHEST
nvm

It's a clinicaldiagnosis 3ribs Fractured in minimum 2 places

ATLS Says 3 ribs fracture Cor
1 rib fracturedat Costco
Chondraljunction
CH PARADOXICALRESPIRATION
during inspiration theFlailsegmentalone moveinside
during exspiration theFlailsegmentalone move outside
HYPOXIA dlt Pain
Underlying pulmonary
contusion

Mostimportant prognostic
factorof flailchest
IOC CT Thorax
3D Reconstruction
Itwillalsoshow UnderlyingLungparenchyma
Px Analgesics Inspiteof Pa025601
NasalOz this Pte RR 181 minute

Intermittent Positive PressureVentilation IPPV

Newconcept Sxis done C Internal Fixation
DIAELIRIEM INTI
causedby

BLUNTTRUAMA PENETRATING TRAUMA

is dtt Fracture of Rib seen below 5th ICS
MC on Ltside Rtside woundwillbe bigger

Injury to Diaphragm Thorax pressure is negative

4
Itwillsuckthebowelcontent tothorax
to
compressthatpartofthorax
Whenyouwill pass Rylestube seen in thoracic cavity
Bag mask ventilation CII
Go for IPPV
BERG41ST TRIAD Rib
Pelvis1Spine
Diaphragm
MCorgan herniate stomach colon
Operated via Laparotomy suturewith PROLENE
AORTIC
ummm
INJURY
ummm
Seendistal to ligmentumarteriosum Tear ordisruption happen
to
Sometimes itcancause FALSEANEURYSM
blood cantrackalongfalse passage
Clf Disproportionate BP btw Upperlimb Corl
bw Upper Lowerlimb
X Raychest widened mediastinum
IOC in Unstable Pt Trans esophageal ECHO TEE
Stable Pt CTscan
Management Keep BP 5120mmHg bygiving shortactingESMOLOL
Endovascular stentingCorl DACRON Graftfor Aortic
Replacement

TRACHEO
ummm
BRONCHIAL
ummm
INJURIES
ummm

Massive airleakseen
Intubate the unaffectedlung inflate it
to
shift to OT
Iv
do Thorocotomy Repair
ABDOMINAL
mmmm INJURIES
mmmm

DIAGNOSTIC
innummun
PERITONEAL
mummmm LAVAGE
mmmm DPD
Insert a cannula at the Umblicus in a layingdownpatient
1
Throughthisinfuse 1hRinger Lactate
1
Ask pt to lay Rt Lt side
I
Ask pt to letoutthefluid
4
Fluid collected in a bag sendforanalysis
f onputting a catheter youraregetting
i 20Mt FrankBloodimmediately
ii 71 Lakh RBC1µL
iii 500WBC1µL
on we
lie Ii.frfinap'III
Disadvantage i Invasive
ii Non Repetitive
iii False tire NontherapeuticLaprotomyhappens
 FAST
emmmm
eFAST Extended FocussedAssessment withSonographyforTrauma
Usedfor 6 Regions
Done by Casualitydoctors
Traumasurgeons trained for FAST
A
BEEEKEIHEREH
PERICARDIUM

E t
SPLEEN
LIVER

STRATOSPHERESIGN
BARCODE SIGN
SEASHORESIGN IfI
PELVIS
Advantages i Repitive
ii Noninvasive
iii Bedsideinvestigation
iv Shorttimestudy
DISADVANTAGES Detect blood 7100Mt only
can't detect BowelInjury
Unreliablefor Retroperitonealcollection
Operatordependent
Not useful for Penetrating Injury
IOC for Unstable pt eFAST
stable pt CTScan
ABDOMEN INJURIES ACCORDING TO ORDER
mmmm mmmm mmmm mmmm

BLUNTTRAUMA PENETRATINGTRAUMA GUNSHOT SEATBELT INI

1 Spleen 1Liver 1SmallBowel 1MCMesenteric
2 Liver 23Small
Bowel 2Colon Tear
3SmallIntestine Diaphragm 2 InGIT DJ
4 Colon Flexureinjury

Urban Bombblast EARDRUM LUNG

blast
UnderwaterBomb GIT CMC in terminalIleum
BLUNTTRAUMA
ummm ummm
PROTOCOL
ummm

STOMACH
mmmm

MC mechanism of injury Penetrating Trauma

In BLUNTTRAUMA Greatercurvature nearantrum
In PosteriorTrauma Don't misstheposteriortear if present
Ttt Surgery Repair ofrent
SMALLBOWEL
nvm ummm INJURY
ummm

MC mechanism BLUNTTrauma Penetrating Trauma

Urgent Sx needed
If stable PrimaryRepair
If unstable CLIP DROPTECHNIQUE
proximalBowel as STOMA

DistalBowel iskeptinabdominalcavity
LINNA itselfbystapling
COLON INJURY
ummm
nvm

MC mechanism PENETRATING TRAUMA

Stable PrimaryRepair
Unstable Clip Droptechnique
RECTAL
ummm INJURY
ummm

MCmechanism penetratingtrauma
 Unstable Highcontamination OPERATION
ALTMANN'S
OProximalPart colostomy
Distalpart Closure

4
µy
Reverse it after2months

DIEDEIEELEIDEREELEE DIEREILAE Mort

MC Mechanism BLUNT Trauma Mcsite NeckofPancreas
Penetrating Trauma MCsite Equal in Head Neck Tail
IOC CECTAbdomen
PPL Elevation of Amylase if duct disruptionpresent
Serum amylase willbe elevated in 501 cases
Ifmum stable
Pt ismurmur
1 DistalPancreatectomy 1 Splenectomy in Distal Pancreatic Injury
2 BEGER PROCEDURE
ifDUODENUMisnormal1 Pancreaticheadinjury
Duodenumpreservingpancreatic headresection

3 TRAUMA WHIPPLE'S
Ifduodenum 1 Pancreaticinjury
Pancreashead1 Duodenum will beremoved
Reconstructionwillbedonelater

4 Ifisolated Duodenalinjury Repairit primarily withomentalPatch

Ifnvm
Pt isunstable
mmmm

1RIPPLETUBEOSTOMY 15 DONE
k
YEnEihg Gastrostomy
Removingthe K
Content Pyloric Exclusion Closepylorus
x
B Venting duodenostomy
Iv
Cc Feeding Jejunostomy