ABCs Evaluation of Trauma Patient

1
ABCs Evaluation of Trauma Patient

• By
• Dr. Mahmoud Shehadah Al hariri
• Emergency Medicine
• Orthopedic surgery

2
Primary Survey

• Airway C-spine
• Breathing
• Circulation
• Exposure
• Disability

3
Secondary Survey

• Mechanism of the injury
• Systemic evaluation
• Definitive treatment

4
Airway and C-spine control

• Assessment
• Ascertain patency
• Immobilization of C-spine hard collar
• 
  sand bags
• 
  tape

5
A C

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

6
Collar application
7
A C patency
8
A C FB
9
A C airways
10
A C

• NASO

• ORO

11
A C Laryngeal mask
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
A CTracheal Intubation
18
A C Surgical Cricothyroidotomy
19
(No Transcript)
20
A C Needle Cricothyroidotomy
21
(No Transcript)
22
Breathing

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

23
B

• Management
• Administer high concentrations oxygen
• Ventilate with a bag-valve-mask or face-mask
• Attach an end-tidal CO2 and pulse oximetery
• Attention to
• Alleviate tension pneumothorax
• Seal open pneumothorax
• Flail chest

24
B
25
End-tidal CO2

• Qualitative

• Quantitative

26
Haemothorax

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

27
Flail chest
28
Flail chest

• Management
• Stabilization
• Observation
• Mechanical ventilation

29
(No Transcript)
30
Pneumothorax
31
Pneumothorax

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

32
Circulation

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

33
C compession
34
C

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

35
Classes of Shock
36
Traumatic Types of Shock

• Hypovolemic ( low CVP )
• Cardiogenic ( high CVP )
• Neurogenic ( low HR )

37
Disability

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

38
Exposure

• Completely undress the patient
• Prevent hypothermia

39
Revised trauma score
Respiratory rate Systolic pressure Glasgow Number
10 - 29 gt 89 13 -15 4
gt 29 76 - 89 9 - 12 3
6 - 9 50 - 75 6 - 8 2
1 - 5 1 - 49 4 - 5 1
0 0 3 0
40
??????? ??????? ?? ??????
??? ????? ??????? ??? ????? lt 3 ????? lt 5 ??? ?? ??? ???? 5-10 ??? gt 10 ???
???? ???? ????? ?????? ?? ??? ?? ??? ????? ??????
???? ?????? ???????? ????? ????? ?????? ?? ??? ????? ?????? ????? ??????
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
THANKS..
46
MoKazem.com

• ??? ???????? ?? ?? ????? ??????? ?? ??????? ?
  ??????? ?? ??? ??????? ???????? ?? ???? ???????
  ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
• ?????? ??? ????? ?? ??????? ??????? ?? ???
  ????????.
• This lecture is one of a series of lectures were
  prepared and presented by residents in the
  department of orthopedics in Damascus hospital,
  under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may
  exist in this lecture.

?. ???? ????
Dr. Muayad Kadhim