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Principles of Trauma Management

This document outlines the principles of trauma management according to ATLS (Advanced Trauma Life Support) guidelines. It describes the stages of trauma management including the primary survey to address life-threatening injuries, secondary survey to identify all injuries, and definitive care. Key components are identifying and treating airway, breathing, circulation problems first followed by disability, exposure assessment. The trauma team approach and importance of early transfer for definitive care after initial resuscitation are also emphasized.

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DrArish Mahmood
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971 views60 pages

Principles of Trauma Management

This document outlines the principles of trauma management according to ATLS (Advanced Trauma Life Support) guidelines. It describes the stages of trauma management including the primary survey to address life-threatening injuries, secondary survey to identify all injuries, and definitive care. Key components are identifying and treating airway, breathing, circulation problems first followed by disability, exposure assessment. The trauma team approach and importance of early transfer for definitive care after initial resuscitation are also emphasized.

Uploaded by

DrArish Mahmood
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PRINCIPLES OF

TRAUMA
MANAGEMENT
TRAUMA:
 TRAUMA IS
THE STUDY
OF MEDICAL
PROBLEMS
ASSOCIATED
WITH PHYSICAL
INJURY
ATLS
 ADVANCED TRAUMA LIFE
SUPPORT
 TRAUMA MANAGEMENT TRAINING
PROGRAM ……..1970’s IN USA.
BASIS IN ATLS:
 TREAT LETHAL INJURY
FIRST, THEN REASSESS
AND TREAT AGAIN
ATLS COMPONENET
STEPS:
 PRIMARY SURVEY:
(Identify what is killing the
patient)
 RE SUSCITATION:
(Treat what is killing the
patient)
 SECONDARY SURVEY:
(Proceed to identify all other
injuries)
 DEFINITIVE CARE:
(Develop a definitive
management plan)
PRE HOSPITAL
RETRIVAL AND
MANAGEMENT:
 “Golden hour”
POLICIES:
 Scoop and run
 Stay and play
 Gloves
 Two finger sweep
 Suction
 Chin lift and jaw thurst
 Airway patency:
- oropharyngeal
 Nasopharyngeal airway
Endotracheal tube:
Cricithyroidotomy:
 Stabilise cervical spine
 Oxygenation
 Covering and sealing of open chest
wound
 Control of external bleeding by
pressure
 Save IV access with two wide bore
cannulas
 Neurological status:
 “AVPU” method
 A – alert
 V -- response to Voice
 P-- response to Pain
 U-- Unresponsive
 Pupils , size and reaction
 Obvious long bone fracture:
alignment and traction splint
MANAGEMENT IN
HOSPITAL
PLANNING AND
PREPARATION:
 Hospital should be informed early
 Preparation of resuscitation area
THE TRAUMA TEAM:
 Multidisciplinary team approach
 Trauma team leader
 Additional physicians…. Airway management,
primary and secondary survey
 Radiographers
 Neurosurgeon
 General surgeon
 Orthopedic surgeon
 Spokes person
 Handing over the patient:
 “MIST”
 M.. Mechanism of injury
 I.... Injuries identified
 S…vital Signs at the scene
 T…Treatment given
PRIMARY SURVEY
AND
RECUSCITATION :
ABCDE of trauma
management:
 A- Airway maintenance and cervical
spine protection
 B- Breathing and ventilation
 C- Circulation with haemorrhage
control
 D- Disability: neurological status
 E - Exposure, completely undress the
patient and assess of other injuries
AIRWAY AND
CERVICAL SPINE
PROTECTION:
 Check verbal response
 Inspection :foreign bodies
fractures :maxilla,
mandible
injury: trachea, larynx
edema
 GCS: < 8 …..definitive airway
 Oxygen supplementation
 Injury to cervical spine:
- injury above clavicle
- loss or alteration of consiousness
-history of neck pain
AIRWAY AND
BREATHING:
 Exposure
 Examination
-inspection
-palpation
- percussion
-auscultation
Immediately life threatening
thoracic conditions:

 1: Aairway obstruction
 2: Tension pneumothorax
T/M: ( needle thoracocentesis ,
tube thoracostomy)
 3: Open pneumothorax:
(sucking wound)
T/m: 3 sided dressing,
tube thoracostomy
 Massive hemothorax
 ( >1500 cc blood)
 T/m : active resuscitation followed by
tube thoracostomy)
 Flail segment with pulmonary
contusion
 T/m: endotracheal tube with
mechanical ventilation
 Cardiac temponade
 T/m: needle percardioncentesis
followed by thoracotomy and repair
CIRCULATION AND
CONTROL OF
BLEEDING:
 CONSIOUS LEVEL
 SKIN COLOUR
 PULSE
 IV assess:
 2 wide bore cannulas
 Venous cut down
 Blood grouping and cross matching
 Fluids given
 20 ml/kg body weight
 Responces :
 1: immediate and sustained return
 2: transient response with later
 deterioration
 3: no improvement
DISABILITY:
 Glascow coma scale
 Hypoglycemia, alcohol and drug
abuse
EXPOSURE:
Log roll:
Spinal allinment
Hypothermia -> warming air
blankets
ADJUNCTS TO
PRIMARY SURVEY:
 ECG
 Urinary catheter
 Gastric catheter
 Radiograph of cervical spine and chest
and pelvis
 Specialised imaging: ultrasound, CT
scan, angiography, diagnostic
peritoneal lavage
SECONDARY
SURVEY:
 Patient’s history: “AMPLE”
 A: allergy
 M: medication including tetanus
 P : past medical history
 L: last meal
 E: events of the incident
HEAD TO TOE EXAMINATION:

 Head and face:


 Open head fracture
 Ocular injury
 Facial fracture
 Bleeding or discharge from ear
NECK:
 Inspect and palpate
 Cervical spine stabilisation
 Wound exploration if platysma deep
CHEST:

 Inspection (log roll)


 Palpation
 percussion
 auscultation
NEUROLOGICAL:

 GCS re- evaluation after every 15 min


 Full neurological examination
ABDOMEN AND PELVIS:

 Inspection: abdomen, prenium


 Palpation
 Rectal examination
EXTREMITIES:

 Obviously deformed limbs


 Document neurovascular status
 Movements of joints
RE- EVALUATION:
 Vital signs
 Urinary out put (0.5 ml/kg)
 Pulse oximetery
 Details examination of hands, feet
and ankels
ANALGESIA:
 Pain and anxiety can change vitals
 Titrated intravenous dose of opiate
DOCUMENTATION
AND LEGAL
CONSIDERATION:
 Time documentation
 Consent
 Forensic evidence
DEFINITIVE CARE
AND TRANSFER:
 Transfer of the patient to respective
department for further management
TAKE HOME
MESSEGE:
 “EARLY TRANSFER OF INJURED
PATIENT AFTER EFFECTIVE AND
AGGRESSIVE INITIAL
RECUSITATION IS THE MOST
IMPORTANT CONTRIBUTOR OF
SUCCESSFUL OUTCOME”

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