ABCs Evaluation of Trauma Patient By Dr Mahmoud

ABCs Evaluation of Trauma Patient By Dr. Mahmoud Shehadah Al hariri Emergency Medicine Orthopedic surgery

Primary Survey Airway & C-spine Breathing Circulation Exposure Disability

Secondary Survey Mechanism of the injury Systemic evaluation Definitive treatment

Airway and C-spine control Assessment l Ascertain patency l Immobilization of C-spine ; hard collar sand bags tape

A&C Management l Chin lift Vs jaw thrust l Clear the airway of foreign bodies l Oropharyngeal or nasopharyngeal airways l Definitive airway ( intubation, LMV, Cricothyroidotomy…. . )

Collar application

A & C ; patency

A & C ; FB

A & C ; airways

A&C NASO ORO

A & C ; Laryngeal mask

A & C; Tracheal Intubation

A & C; Surgical Cricothyroidotomy

A & C; Needle Cricothyroidotomy

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

B Management l Administer high concentrations oxygen l Ventilate with a bag-valve-mask or face-mask l Attach an end-tidal CO 2 and pulse oximetery Attention to; l l l Alleviate tension pneumothorax Seal open pneumothorax Flail chest

B

End-tidal CO 2 Qualitative Quantitative

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

Flail chest

Flail chest Management Stabilization Observation Mechanical ventilation

Pneumothorax

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

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

C ; compession

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

Classes of Shock

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

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

Exposure l Completely undress the patient l Prevent hypothermia

Revised trauma score Number Glasgow Systolic pressure Respiratory rate 4 13 -15 > 89 10 - 29 3 9 - 12 76 - 89 > 29 2 6 -8 50 - 75 6 -9 1 4 -5 1 - 49 1 -5 0 3 0 0

THANKS…. .