Multiple Trauma

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Multiple Trauma
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Etiology

• Affects 50 million Americans per year
• Leading cause of death in ages 1-44
• Fourth leading cause of all deaths
• Cost 100 billion to U. S society annually
• Research only 4 of US federal research
  dollars
• Most trauma is preventable!

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Mechanisms of Injury

• Blunt Trauma
• Injuries caused by rapid change in velocity
• Deceleration injuries
• Body stops, tissues and organs continue to move
  forward
• Can measure force wt. X speed
• Ex. 130 lb. F going 60 mph 7800 lbs of force
• MVAs, MCAs, falls, contact sports

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Mechanisms of Injury

• Penetrating Trauma
• Object penetrates internal tissues causing injury
• Can be misleading small surface, lg.internal
• Injuries depend on depth, angle, device, location
• Stabbings, firearms, implements
• Other causes heat, electricity, poisons, water
  (near drowning)

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Phases of Trauma Care

• The military M.A.S.H. !!
• E. M. S. across U.S.
• Goal ? time from event to definitive care
• 3 Peaks of fatalities
• 1st Peak- 50 of deaths, before care arrives
• 2nd Peak-30 golden hour - actually first few
  hours
• 3rd Peak- 20- days, weeks post event

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Trimodal Death Distribution
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6 Actual Phases of Care...

• Prehospital
• Emergency Department
• Operative Phase
• Critical Care Phase
• Intermediate Phase
• Rehabilitation Phase

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A little more detail.

• Prehospital Care
• Stabilize A,B,Cs
• airway, breathing, circulation
• Safely transport Neck immobilization
• Air or Ground transport

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Emergency Department Care

• ATLS, TNCC
• Advanced Trauma Life Support A
  Systematic Approach
• Trauma Nurse Core Course
• Primary, Secondary Survey along with
  resuscitation and management

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Primary Survey

• 5 steps A-B-C-D-E
• Airway
• Ineffective clearance drug overdose, LOC, Lung
  or airway trauma
• Obstruction foreign bodies, clots, teeth
• Intubation, cricothyrotomy
• Breathing ventilation
• O2 on all trauma victims
• artificial ventilation
• chest tube placement

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• Circulation
• Assess for cardiac output, tissue perfusion,
  fluid volume deficit
• Systolic B.P. assessment, quick method
• 80- peripheral pulse palpation
• 70-femoral pulse palpation
• 60 -carotid pulse palpation
• ACLS Protocols
• MAST pants, PASG --controversial

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• Disability
• Assessment of other potential for injury--
• Brief Neuro assessment
• A-Alert
• V-respond to verbal stimuli
• P-Responds to painful stimuli
• U-unresponsive
• Exposure
• Undress
• control body temp.
• A-B-C-D-E Still Primary Survey

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Resuscitation Process

• Treat hypovolemia!!
• Lg, bore IVs, Central line placement
• Crystalloids, colloids, blood
• Warming possibilities
• Draw blood samples CBC, Lytes,coags, Type and X,
  ABGs , PG test, Tox. ETOH levels, LFTs
• GI, GU catheters

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Secondary Survey

• Examination of each body system
• Importance of history
• Event history
• Past medical history
• Further testing
• EKG, CXR, CT Scan, MRI,
• Peritoneal lavage-test, drain
• Family communication

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Tertiary Survey

• Within first 24 hours
• Thorough system by system, head-to-toe approach
• Goal Have we missed anything???

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Operative Phase

• Trauma is almost always a Surgical Event
• Need to go in and mechanically repair
• To PACU or directly to Critical Care Unit
• Trauma ICU
• Surgical ICU
• Neuro-surgical ICU
• Burn/Trauma ICU

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Critical Care Phase

• Initial assessment
• Primary, Secondary survey methods
• Continue stabilization
• Complete cleaning ( hair, wounds, etc. )
• Complication Prevention
• Infection, ARDS, DIC, embolisms, renal failure,
  compartment syndrome, MSOF, SIRS
• O2 Supply/ Demand balance
• Pain Management
• Communication Patient and family

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Intermediate and Rehabilitation Phases

• Continue with prioritization of Care
• ABCs
• Complication prevention, management
• Nutrition
• Mobilization
• Pain management
• Altered body image
• Communication
• Goal setting

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Trauma body systems

• Head Injuries 50 of all trauma deaths
• Spinal Cord Injuries Partial vs complete
• Maxillofacial Injuries Complex, Airway!, sensory
  functions
• Thoracic Injuries
• Chest wall, heart, lungs, aorta other large
  vessels, esophagus, diaphragm tears
• Abdominal Injuries risk of perforation
• Pelvic Injuries vessel risk, GU damage

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Case Study..
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TRUAMA

• Care across a continuum
• Multidisciplinary, team approach
• Systematic Approach
• Prioritization!!!!
• Prevention