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Description : Check out this medical titled "Management of the Trauma Patient" by Hieu Ton-That, MD, FACS.

This medical talks about Management of the trauma patient which requires a systematic approach and involves the assessment and treatment of life-threatening injuries.

The management of the trauma patient requires a coordinated effort between healthcare providers, including emergency medical services, emergency department personnel, surgeons, and other specialists. A systematic approach, starting with the primary survey and continuing through definitive care and ongoing care, is critical for the best possible outcomes.

Tags : Management of the Trauma Patient, emergency medical services, emergency department personnel, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 1100 | Downloads : 0

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Slide 1-

Management of the Trauma Patient Hieu Ton-That, MD, FACS Loyola University Medical Center Division of Burns, Trauma and Surgical Critical Care
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Trauma in the United States 2.7 million hospital admissions per year Leading cause of death for ages 1-44 years 100,000 deaths per year from traumatic injuries Half die before they reach medical care Hemorrhage is second-leading cause of death in trauma
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Figure 6A: Number of Incidents by Age
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Figure 7A: Number of Incidents by Age and Gender
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Figure 8A: Case Fatality Rate by Age
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Figure 10A: Number of Incidents by Mechanism of Injury
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Primary Survey Advanced Trauma Life Support Assess and address life threatening injuries in order “ABCDE of trauma” Airway Breathing Circulation Neurologic “deficit” Exposure of patient
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Airway Identify airway obstruction Maintain cervical spine immobilization May require definitive airway Orotracheal intubation Blind nasotracheal intubation Cricothyroidotomy Tracheotomy
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Breathing Identify life threatening deficits in breathing mechanism Simple pneumothorax Tension pneumothorax Massive hemothorax Open pneumothorax (“sucking chest wound”) Flail chest
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Circulation Or, identification of shock Definition of shock – inadequate organ perfusion Causes of shock Hemorrhage/hypovolemia Compressive Cardiogenic Neurogenic Sepsis
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Circulation Treatment of shock Direct pressure on external bleeding Initial 2 liter bolus of crystalloid fluid Responders Non-responders Transient responders Definitive management for ongoing hemorrhage
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Neurologic “deficit” Rapid assessment of neurologic status to identify life-threatening injury Pupil size and response Mental status (Glascow coma scale) Motor and sensory exam
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Glascow Coma Scale 3 – 15 point scale to assess mental status only Best observed response Modified scale for children GCS ≤ 8 is a “coma” and requires intubation for airway protesction
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Eye opening None = 1 To painful stimuli only = 2 To voice only = 3 Spontaneously open = 4 Verbal response None = 1 Incomprehensible sounds = 2 Incomprehensible words = 3 Confused = 4 Oriented = 5 Motor response None = 1 Decerebrate (extension) posturing = 2 Decorticate (flexion) posturing = 3 Withdraws to pain = 4 Localizes pain = 5 Follows commands = 6
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Exposure Head to toe examination of the patient for injury Pitfalls Maintenance of spine precautions Prevention of heat loss Under cervical collar Back and flanks
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Adjuncts to the Primary Survey Exams during or after primary survey to aid in identifying life-threatening injuries Chest x-ray Pelvis x-ray Focused abdominal sonogram for trauma (FAST) Diagnostic peritoneal lavage (DPL)
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Secondary Surveyand Definitive Treatment The secondary survey is a complete head to toe evaluation of the patient Adjuncts to the secondary survey include CT’s, plain radiographs, blood tests Treatment plans, especially for multiple injuries, based on clinical status and specific injuries
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Resuscitation Restoring organ perfusion How much is enough? What are the endpoints of resuscitation? Heart rate, blood pressure, urine output May lead to “compensated shock” Organ-specific indicators of perfusion ie gastric tonometry Global indicators of perfusion Lactic acid, base deficit Cardiac output, oxygen delivery, oxygen consumption Mixed venous O2 saturation (SvO2)
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Lactic acid and base deficit Initial BD and serum LA are reliable indicators of the need for ongoing resuscitation Time to normalization of LA and BD are predictive of MSOF and mortality
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Damage-control laparotomy A shift from definitive management of abdominal injuries to stabilizing the patient for resuscitation Goals Stop bleeding Control contamination Temporary abdominal closure
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Critical care and rehabilitation
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Questions?