Corrected Trauma Manual Volume 1

CORRECTED TRAUMA MANUAL VOLUME 1.

CHAPTER 1: INTRODUCTION- PRIMARY AND SECONDARY SURVEY

AIMS AND OBJECTIVES OF Trauma Manual :

1. Assess a patient’s condition rapidly and accurately.

2. Resuscitate and stabilize patients according to priority.

3. Determine whether a patient’s needs exceed a facility’s resources and/or a doctor’s capabilities.

4. Arrange appropriately for a patient’s interhospital or intrahospital transfer (what, who, when, and how).

5. Ensure that optimal care is provided and that the level of care does not deteriorate at any point during the evaluation, resuscitation, or transfer

processes.

TRAUMA STATISTICS

WHO estimates that more than 9 people die every minute from injury with over 1 million people dying each year from road traffic accidents. Trauma is the commonest cause of death in 1-44 year olds in the developed world. For every death from trauma there are 3 people who suffer permanent disability.

DEATHS AFTER TRAUMA OCCUR IN 3 PEAKS

Deaths occur after trauma in three periods :

Immediate deaths: Some 50% of deaths occur within seconds to minutes after injury. Severe brain or high spinal cord injury causing apnea or rupture of heart, aorta or large vessels leads to immediate deaths that are usually not salvable. A small number of these cases which have airway obstruction or external hemorrhage can be saved by first-aid measures. For the rest only preventive measures like reduction in vehicle accidents will reduce the number of these deaths.

Second Peak in deaths : Occur from minutes to several hours of injury. Some 30% die within 1-3 hours. The cause usually is head injury (epidural, subdural hematoma); solid organ laceration (spleen/ liver/ kidney injury); hemo/ pneumothorax; pelvic fracture or multiple injuries associated with significant blood loss. As the most often underlying mechanism is hypoxia or hypovolemic shock -Prompt assessment and resuscitation within the first hour after injury (golden hour) will save several of these deaths.

Third peak in deaths : Occurs days to weeks after injury. The cause of these deaths is usually sepsis or multiple organ failure. The quality of  care provided after injury directly affects the number of people dying from sepsis or MODS.

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