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Trauma Management (PRIMARY SURVEY (Breathing
Adequacy of Ventilation…
Trauma Management
PRIMARY SURVEY
Circulation
- 5 Major Sites of Blood Loss: External, Thoracic Cavity, abdominal Cavity, Pelvis and Retro peritoneum, Long bones
- Imaging on Arrival: CXR, PXR, eFAST Scan
- 2 large bore Cannulaes
- Bloods G&H, VBG + lactate, / Hb, FBC, UEC, LFT's, Lipase, Glucose
- Fluid Resus → SBP >80mmHg or 90-100mmHg if head injury
- ? Blood tranfusion
- +FAST scan → OT for Laparotomy
- Pelvic #: Pelvic binder
- Stable patients → CT
PANEL OF INVESTIGATIONS
Breathing
Adequacy of Ventilation and Oxygenation
- Assess: Lungs, Chest wall and Diaphragm
- Inspect: Cyanosis, Jugular Venous Distention ( Temsion Pneumothorax, Cardiac Tamponade), Flail chest, Pentrating Chest trauma, Accessory muscle use, Resp. Distress.
- Auscultate: Stridor, reduce AE, ( Penumothorax, haemothorax)
- Percuss: Hyper-resonance ( PNeumothorax), dullness (Haemothorax), subcutaneous emphysema, point tenderness (rib fractures)
- Investigations: Chest XRAY and Lung US
- Initial MAnagement: High Flow O2 or NIPPV
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Disability
- GCS, Gross Motor movements of Limbs, Pupilary responses, corneal refelxes
- GLUCOSE
- RICP/Impeding Herniation: " Blown pupil", Bradycardia and Hypertension( Cushing Reflex) and ↓ GCS by points /in patients with GCS <8/15. Tx: Hyperventated ( PCO2 30-35mmHg) & mannitol/hyper tonic saline
- Severe head Injury → CT Brain (?SDH, EDH)
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Indications for Intubation:
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Secondary Survey
- Head to toe examination of the patient looking for other injuries, which are not life threatening.
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Tertiary Survey
- complete examination of the patient and a review of all the ordered investigations. It occurs in a delayed fashion generally 24 hours after the initial admission to hospital.
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