Initial Assessment & Management Polytrauma: July 4, 2015 1

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN
ELIZABETH
LECTURE 1
INITIAL
ASSESSMENT
&
MANAGEMENT
POLYTRAUMA
July 4, 2015
MANAGEMENT OF POLYTRAUMA

ELIZABETH
CASE SCENARIO
What is the sequence of priorities in assessing

this patient?
44-year-old male driver who
crashed head-on into a wall
Patient found unresponsive at the
scene
Arrives at hospital via basic life
support with c-collar in place and
strapped to a backboard; Lions
ambulance assisting ventilations
with bag-mask
July 4, 2015

ELIZABETH
OBJECTIVES
Apply principles of primary and

secondary surveys
Identify management priorities
Institute appropriate resuscitation
and monitoring procedures
Recognize the value of the patient
history and biomechanics of injury
Anticipate and manage pitfalls
July 4, 2015

ELIZABETH
STANDARD
PRECAUTIONS
Cap
Gown
Gloves
Mask
Shoe covers
Goggles / face
shield
July 4, 2015

ELIZABETH
CONCEPT OF INITIAL
ASSESSMENT
Primary Survey
Definitive Care
Adjuncts
Resuscitation
Reevaluation
Reevaluation
Detailed
Secondary
Survey
Adjuncts
Primary survey and resuscitation of vital functions are done

simultaneously using a team approach.
July 4, 2015

ELIZABETH
QUICK ASSESSMENT
What is a quick, simple way

to assess a patient in 10
seconds?
July 4, 2015

ELIZABETH
QUICK ASSESSMENT
Identify yourself
Ask the patient his or her name
Ask the patient what happened
July 4, 2015

ELIZABETH
QUICK ASSESSMENT
APPROPRIATE RESPONSE CONFIRMS

:
Patent airway
Sufficient air reserve to permit

speech
Sufficient perfusion to permit

cerebration
D
July 4, 2015
Clear sensorium

ELIZABETH
PRIMARY SURVEY
Airway with c-spine protection

Breathing with adequate oxygenation
Circulation with hemorrhage control
Disability
Exposure / Environment
July 4, 2015
PRIMARY SURVEY :
AIRWAY

ELIZABETH
Establish patent airway

and
protect c-spine
Pitfalls
Occult airway injury

Progressive loss of
airway
Equipment failure
Inability to intubate
July 4, 2015
10

ELIZABETH
PRIMARY SURVEY
: BREATHING
Assess and ensure adequate oxygenation

and ventilation
Respiratory rate
Chest movement
Air entry
Oxygen saturation
July 4, 2015
Pitfalls
Airway versus ventilation

problem?
latrogenic pneumothorax
or
tension pneumothorax?
11

ELIZABETH
PRIMARY SURVEY
Assess for organ perfusion by :
Level of
consciousness
Skin color and
temperature
Pulse rate and
Management for organ perfusion by :
character
Control
hemorrhage
CIRCULATION
Pitfalls
Elderly
Children
Athletes
Medications
Restore volume
Reassess patient
July 4, 2015
12

ELIZABETH
PRIMARY SURVEY
: DISABILITY
Baseline neurologic
evaluation
Glasgow Coma Scale
score
Pupillary response
Caution
Observe for
neurologic
deterioration
July 4, 2015
13

ELIZABETH
PRIMARY SURVEY
EXPOSURE / ENVIRONMENT
Completely undress the patient

Caution
Prevent
hypothermia
Pitfalls
Missed
injuries
July 4, 2015
14

ELIZABETH
RESUSCITATION
Protect and secure airway

Ventilate and oxygenate
Stop the bleeding!
Vigorous shock therapy
Protect from hypothermia
July 4, 2015
15

ELIZABETH
ADJUNCTS TO PRIMARY
SURVEY
Vital signs
ABGs
ECG
PRIMARY SURVEY
Urinary
output
Urinary / gastric catheters
unless contraindicated
July 4, 2015
Pulse
oximeter
and CO2
16

ELIZABETH
ADJUNCTS TO PRIMARY
SURVEY
DIAGNOSTIC TOOLS
July 4, 2015
17

ELIZABETH
ADJUNCTS TO PRIMARY
SURVEY
DIAGNOSTIC TOOLS
1.Fast
2.DPL
July 4, 2015
18

ELIZABETH
SECONDARY SURVEY
The complete history and physical

Components of
examination
When to start the secondary survey?

After
Primary survey is
completed
ABCDEs are
reassessed
Vital functions are
returning to normal
July 4, 2015
the secondary
survey
History
Physical exam: Head
to toe
Complete neurologic
exam
Special diagnostic
tests
Reevaluation
19

ELIZABETH
SECONDARY SURVEY
History
Allergies
Medications
Past
illnesses
Last
meal
Events
/ Environment /
Mechanism
July 4, 2015
20

ELIZABETH
SECONDARY SURVEY
Mechanisms of Injury
July 4, 2015
21

ELIZABETH
SECONDARY SURVEY
Head
External exam
Scalp palpation
Comprehensive
eye and ear
exam
Including
visual acuity
July 4, 2015
Pitfalls
Unconsciousness
Periorbital edema
Occluded auditory
canal
22

ELIZABETH
SECONDARY SURVEY
Maxillofacial
Bony crepitus
Deformity
Malocclusion
Pitfalls
Potential
airway
obstruction
Cribriform plate fracture
Frequently missed
July 4, 2015
23

ELIZABETH
SECONDARY SURVEY
Neck (Soft
Tissues)
Mechanism:
Symptoms:
hoarseness
Findings:
Blunt vs penetrating
Airway obstruction,
Crepitus, hematoma, stridor, bruit
Pitfalls
Delayed symptoms and

signs
Progressive airway
obstruction
July 4, 2015
Occult injuries
24

ELIZABETH
SECONDARY SURVEY
Chest
Inspect
Palpate
Percuss
Auscultate
X-rays
July 4, 2015
25

ELIZABETH
SECONDARY SURVEY
Abdomen
Inspect /
Auscultate
Palpate / Percuss
Reevaluate
Special studies
Pitfalls
Hollow viscous injury

Retroperitoneal injury
July 4, 2015
26

ELIZABETH
SECONDARY SURVEY
Perineum
Contusions, hematomas, lacerations,
urethral blood
Rectum
Sphincter tone, high-riding prostate, pelvic
fracture,
rectal wall integrity, blood
Pitfalls
Urethral injury
Vagina
Pregnancy
Blood, lacerations
July 4, 2015
27

ELIZABETH
SECONDARY SURVEY
Pelvis
Pain on palpation
Leg length unequal
Instability
X-rays as needed
Pitfalls
Excessive pelvic
manipulation
July 4, 2015
Underestimating pelvic
blood loss
28

ELIZABETH
SECONDARY SURVEY
Extremities
Contusion,
deformity
Pain
Perfusion
Peripheral
neurovascular
status
X-rays as needed
July 4, 2015
29

ELIZABETH
SECONDARY SURVEY
Pitfalls
Potential blood loss

Missed fractures
Soft tissue or ligamentous injury
Compartment syndrome (especially
with altered sensorium /
hypotension)
July 4, 2015
30

ELIZABETH
SECONDARY SURVEY
Neurologic:
Brain
GCS
Pupil size and
reaction
Lateralizing signs
Frequent
reevaluation
Prevent secondary
brain injury
July 4, 2015
Early
neurosurgical
consult
31

ELIZABETH
SECONDARY SURVEY
Neurologic: Spinal
Assessment
Whole spine
Tenderness and swelling
Complete motor and sensory exams
Reflexes
Imaging studies
Pitfalls
Altered sensorium
Inability to cooperate with

clinical exam
July 4, 2015
32

ELIZABETH
SECONDARY SURVEY
Neurologic: Spine and

Cord
Conduct an in-depth evaluation
of the patients spine and spinal
cord
Early
neurosurgical /
orthopedic
consult
July 4, 2015
33

ELIZABETH
SECONDARY SURVEY
Neurologic
Pitfalls
Incomplete immobilization
Neurologic deterioration
July 4, 2015
34

ELIZABETH
ADJUNCTS TO
SECONDARY SURVEY
Special Diagnostic Tests as Indicated

Pitfalls
Patient
deterioration
Delay of
transfer
Deterioration
during transfer
Poor
communication
July 4, 2015
35

ELIZABETH
PAIN MANAGEMENT
Relief of pain /
anxiety as
appropriate
Administer
intravenously
Careful monitoring is
essential
July 4, 2015
36

ELIZABETH
SUMMARY
Primary Survey
Adjuncts
Resuscitation
Definitive Care
Reevaluation
Reevaluation
Detailed
Secondary
Survey
July 4, 2015
Adjuncts
37

ELIZABETH
ANY
QUESTIONS ?
July 4, 2015
38

ELIZABETH
LECTURE 1
TRAUMA TEAM
CONCEPT &
PHILOSOPHY
July 4, 2015
39

ELIZABETH
INTRODUCTION
TRAUMA TEAM
Many studies in developing countries
have shown that > 30% of total hospital
death is due to trauma.
A well integrated trauma system based
upon TEAMWORK and PARTNERING
can reduce the mortality rate to less than
10%.
July 4, 2015
40

ELIZABETH
TEAM WORK
ORGANISATION OF TEAMWORK
Vertical Team Organization
Horizontal Team Organization

July 4, 2015
41

ELIZABETH
VERTICAL TEAM
ORGANISATION
1. Command & instructions are

determined by the Team Leader.
2. Task carried out sequentially.
3. Focused on Team Leader.
4. Inefficient work culture.
July 4, 2015
42

ELIZABETH
VERTICAL TEAM
TEAM
LEADER
WORKER 1
WORKER 3
WORKER 2
July 4, 2015
43

ELIZABETH
HORIZONTAL TEAM
ORGANISATION
All members carry out individual tasks

simultaneously.
Not focused on any particular team member
or team leader.
Enhance Team Performance and Improved
Outcome.
Most efficient organisation
July 4, 2015
44

ELIZABETH
HORIZONTAL TEAM
TEAM LEADER
WORKER 1
July 4, 2015
WORKER 2
WORKER 3
45

ELIZABETH
TEAM WORK
Features of an efficient teamwork

1. Task divided into manageable units.
2. Specifically allocated to individual
members.
3. Task evenly divided among Team
Members.
4. Task carried out SIMULTANEOUSLY.
July 4, 2015
46

ELIZABETH
TRAUMA TEAM
Current System in Managing Multiple Trauma in

Malaysia.
1. Resuscitation carried out with a mixture of

vertical and horizontal task distribution.
2. Variable team size.
3. Members tend to arrive at different times.
4. Lack of overall coordination.
5. Junior doctors.
July 4, 2015
47

ELIZABETH
TRAUMA TEAM
Trauma Team Structures and

Functions
1. Optimal size depends on the severity
of injuries and experience of the
individual team members.
2. Ideally an 8-member team.
3. The strength of the team is as strong
as its weakest link.
July 4, 2015
48

ELIZABETH
July 4, 2015
49

ELIZABETH
RESUSCITATION ZONE
Resuscitation Zone Layout

A dedicated and proper working area to
facilitate performance of the Trauma
Team.
Golf Swing movement.
July 4, 2015
50

ELIZABETH
ROLE OF TEAM LEADER
Team Leader :
The most experienced personnel
Perform the most important aspects of
the management e.g primary survey
and resuscitation procedures.
July 4, 2015
51

ELIZABETH
TRAUMA TEAM
Development of Trauma Team in Malaysia

Phase I
First 5 - 10 minutes :
ED
3 Member Team from
Phase II
From 3 - 6 hours :
6 Member Team
additional members
from the respective departments.
July 4, 2015
52

ELIZABETH
SUMMARY
Trauma should be managed as

smoothly and as efficiently as a
PIT STOP
in a
FORMULA ONE RACE

July 4, 2015
53

ELIZABETH
INITIAL ASSESSMENT
ANY
QUESTIONS ?
July 4, 2015
54

Initial Assessment & Management Polytrauma: July 4, 2015 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Initial Assessment & Management Polytrauma: July 4, 2015 1

Uploaded by

Copyright:

Available Formats

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

What is the sequence of priorities in assessing

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Apply principles of primary and

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Primary survey and resuscitation of vital functions are done

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

What is a quick, simple way

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

APPROPRIATE RESPONSE CONFIRMS

Sufficient air reserve to permit

Sufficient perfusion to permit

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Airway with c-spine protection

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Establish patent airway

Occult airway injury

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Assess and ensure adequate oxygenation

Airway versus ventilation

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Completely undress the patient

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Protect and secure airway

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

The complete history and physical

When to start the secondary survey?

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Delayed symptoms and

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Hollow viscous injury

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Potential blood loss

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Inability to cooperate with

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Neurologic: Spine and

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

Special Diagnostic Tests as Indicated

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN

QUEEN TRAUMA LIFE SUPPORT COURSE HOSPITAL QUEEN