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Management of Multiple Trauma.: Dr. D. V. Kanishka Kamal

This document outlines the management of multiple trauma according to the Advanced Trauma Life Support (ATLS) guidelines. It describes the trimodal pattern of death following injury, with immediate, early, and late deaths. It then details the ATLS approach of conducting a primary survey to identify life-threatening injuries, resuscitation to treat those injuries, a secondary survey to find all other injuries, and developing a definitive care plan. The primary survey involves assessing the airway, breathing, circulation, neurological status, and exposing the patient in a controlled environment. Appropriate management is then outlined for injuries found in each of these areas.

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Kanishka Kamal
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283 views40 pages

Management of Multiple Trauma.: Dr. D. V. Kanishka Kamal

This document outlines the management of multiple trauma according to the Advanced Trauma Life Support (ATLS) guidelines. It describes the trimodal pattern of death following injury, with immediate, early, and late deaths. It then details the ATLS approach of conducting a primary survey to identify life-threatening injuries, resuscitation to treat those injuries, a secondary survey to find all other injuries, and developing a definitive care plan. The primary survey involves assessing the airway, breathing, circulation, neurological status, and exposing the patient in a controlled environment. Appropriate management is then outlined for injuries found in each of these areas.

Uploaded by

Kanishka Kamal
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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MANAGEMENT OF

MULTIPLE TRAUMA.

DR. D. V. KANISHKA KAMAL


Where should we start ? ?
DEATH FOLLOWING
INJURY

SHOWS A DISTINCT TRIMODAL PATTERN.


DR. DONALD TRUNKEY
CHAIRMAN OF DEPT. OF SURGERY
OREGAN, USA.

IMMEDIATE DEATHS - 50% - within minutes


EARLY DEATHS - 30% - 1-3 hours
LATE DEATHS - 20% - 2-4 weeks

* CONCEPT OF GOLDEN HOURS OF TRAUMA !


HISTORY

1970- DR. JAMES STYNER


AMERICAN ORTHOPAEDIC SURGEON

INTRODUCED A STRUCTURED TRAUMA


MANAGEMENT TRAINING PROGRAMME

AMERICAN COLLEGE OF SURGEONS


DEVELOPED ATLS EDUCATIONAL PACKAGE.
.
PHILOSOPHY

TREAT LETHAL INJURY FIRST,

THEN REASSESS,

AND TREAT AGAIN !


ATLS COMPONENT STEPS
1. PRIMARY SURVEY
- IDENTIFY WHAT IS KILLING THE PATIENT.

2. RESUSCITATION
- TREAT WHAT IS KILLING THE PATIENT.

3. SECONDARY SURVEY
- PROCEED TO IDENTIFY ALL OTHR INJURIES.

4. DEFINITIVE CARE
- DEVELOP A DEFINITIVE MANAGEMENT
PLAN.
PRIMARY SURVEY

SURVEY OF….

1. AIRWAY WITH CERVICAL SPINAL CONTROL


2. BREATHING AND VENTILATION
3. CIRCULATION WITH CONTROL OF HAEMORRHAGE
4. DYSFUNCTION OF THE CNS
5. EXPOSURE IN A CONTROLLED ENVIRONMENT
AIRWAY OBSTRUCTION KILLS IMMEDIATELY !

SECURING AIRWAY WITH


CERVICAL SPINAL CONTROL

CONTROL CERVICAL SPINE


MANUAL INLINE CONTROL
COLLAR/ SAND BAG/ HEAD TAPE

ASSESS AIRWAY

AIRWAY MANAGEMENT
AIRWAY MANAGEMENT
1. CONTROL CERVICAL SPINE
MANUAL INLINE CONTROL
COLLAR/ SAND BAG/ HEAD TAPE

2. CLEAR AIRWAY
TWO FINGER SWEEP
SUCTION
3. MAINTAIN AIRWAY
CHIN LIFT / JAW THRUST

4. PROVIDE AIRWAY
AIRWAY DEVICES
CRICOTHYROIDOTOMY
5. O2 – 14 L / MINUTE
BREATHING AND
VENTILATION
ASSESS - TO IDENTIFY
IMMEDIATELY LIFE THREATENING
CONDITIONS

1. TENSION PNEUMOTHORAX
2. MASSIVE HAEMOTHORAX
3. OPEN PNEUMOTHORAX
4. FLAIL CHEST
Open pneumothorax
Tension pneumothorax
Haemothorax
Flail chest
PROBLEMS IN CIRCULATION

SHOCK.
Hypovolaemic, cardiogenic

Cardiac tamponade leading to


shock.
CIRCULATION AND CONTROL OF
HAEMORRHAGE

ASSESSMENT FOR SIGNS OF SHOCK

CAUSE OF SHOCK

ASSESS THE DEGREE OF BLOOD LOSS


CLASS I, II, III, IV

SITE OF BLOOD LOSS


“ Blood on the floor and four more “
MANAGEMNT OF
A PATIENT IN SHOCK
VASCULAR ACCESS
PERIPHERAL VENOUS CANNULATION
VENOUS CUTDOWN
INTRAOSSEOUS TRANSFUSION

DRAW BLOOD FOR GROUPING & DT AT THE


SAME TIME,

RESUSCITATION
TRANSFUSE 2L OF HARTMAAN SOLN.

ASSESS RESPONSE
IMMEDIATE AND SUSTAINED
TRANSIENT & LATER DETERIORATION
NO RESPONSE
DYSFUNCTION OF THE CNS

ASSESSMENT OF NEUROLOGICAL STATUS


AVPU – ALERT
RESPONDS TO VOICE
RESPONDS TO PAIN
UNRESPONSIVE
MONITORING

PULSE OXYMETER
BLOOD PRESSURE & HEART RATE
ECG
URINE OUTPUT
TEMPERATURE
INVESTIGATIONS DURING
INITIAL STAGE

XRAY CERVICAL SPINE – LATERAL FILM


XRAY CHEST – SUPINE PA
XRAY PELVIS - AP
HISTORY

1. ALLERGIES
2. MEDICATIONS
3. PAST MEDICAL HISTORY
4. LAST MEAL
5. EVENT LEADING TO THE INJURY
EXPOSURE OF THE PATIENT

EXPOSE IN A CONTROLLED
ENVIRONMENT!
FURTHER DECISION
MAKING
RESPONSE TO PRIMARY SURVEY AND
RESUSCITATION INFLUENCES FURTHER
DECISION MAKING

1. NO LIFE THREATENING CONDITION


2. SUSTAINED RESPONSE
3. TRANSIENT RESPONSE
4. NO RESPONSE
SECONDARY SURVEY

HEAD TO TOE EXAMINATION


HEAD, FACE, NECK, THORAX ,
ABDOMEN, PELVIS, SPINAL INJURIES,
EXTREMITIES

VITAL SIGNS MONITORING DEVICES ARE IN SITU

DETAILED RADIOGRAPHIC PROCEDURES


POTENTIALLY LIFE THREATNING
INJURIES
- SECONDARY SURVEY

1. PULMONARY CONTUSION
2. MYOCARDIAL CONTUSIONS
3. AORTIC TEAR
4. DIAPHRAGMATIC TEAR
5. OESOPHAGEAL TEAR
6. TRACHEOBRONCHIAL TEAR
DEFINITIVE CARE PLAN

DECISION ON OWNERSHIP

ATTENTION OF THE OTHER SPECIALISTS


THANK YOU !

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