TRAUM
A
Ceffrian Juriel E. Macad
Medical Clerk SWU-PHINMA
Trauma/
Injury
is defined as cellular disruption caused by
environmental energy that is beyond the
body’s resilience, which is compounded by cell
death due to ischemia/reperfusion
● most common cause of death for all individuals
between the ages of 11 and 44 years
● third most common cause of death regardless of
age
0
1EVALUATION
INITIAL
AND
RESUSCITATION
OF THE INJURED
PATIENT
PRIMARY
SURVEY
The Advanced Trauma Life Support (ATLS):
emphasizes the “golden hour” concept
that timely, prioritized interventions are
necessary to prevent death and disability
PRIMARY
SURVEY
Approach:
■ Primary survey or concurrent
resuscitation
■ Secondary survey/Diagnostic
evaluation
■ Definitive care
■ Tertiary survey
PRIMARY
SURVEY
GOAL: to identify and treat conditions that
constitute an immediate threat to life.
○ The ATLS course refers to the primary
survey as assessment of the “ABCs”
■ Airway with cervical spine
protection
■ Breathing and Ventilation
■ Circulation with Hemorrhage
Control
■ Disability and Exposure
PRIMARY
SURVEY
■ Airway Management with Cervical Spine
Protection
● First priority: Ensure a patent airway
■ All patients with blunt trauma require
cervical spine immobilization until injury is
excluded
● Cervical collar
● Sandbags on both sides of the head
with the patient’s forehead taped
across the bags
ESTABLISHING A DEFINITIVE
AIRWAY
Indications:
● I- instability,
hemodynamic
● N- neck
hematoma/trauma
● T - trauma to the face
● U - unresponsive
● B- bleeding
● A- airway
compromise/Apnea
● T- thermal inhalation
OPTIONS FOR ENDOTRACHEAL
INTUBATION
CORRECT ENDOTRACHEAL
PLACEMENT
1. Direct Laryngoscopy
2. Capnography
3. Audible bilateral breath
sounds
4. Chest X RAY
BREATHING AND VENTILATION
1. Assess for respiratory rate and oxygen
saturation
2. Inspect for external signs of trauma and
asymmetric chest movements
3. Palpate chest wall for injury (e.g
crepitus, subcutaneous emphysema,
deviation of trachea
4. Auscultate chest wall for breath sounds
5. Suspect life-threatening conditions due to
inadequate ventilation
CIRCULATION AND CONTROL
HEMORRHAGE
1. Look for evidence of bleeding
● Any episode of hypotension (SBP <90
mmHg) is assumed to be caused by hemorrhage
until proven otherwise
2. Systolic blood pressure (SBP) can be palpable
● Carotid pulse: 60 mmHg
● Femoral pulse: 70 mmHg
● Radial pulse: 80 mmHg
3. Poor peripheral perfusion
● Pale skin, CRT> 2 seconds
APPROACH TO
SHOCK
Disability and Exposure
PEDIATRIC GLASGOW COMA
SCALE
SECONDARY
SURVEY
● Rapid, systematic and head-to-toe
examination approach to identify other
injuries missed in the focused primary
survey
● Includes Radiography, laboratory tests,
scans and peritoneal lavage
SECONDARY
SURVEY
A-M-P-L-E
● Allergies
● Medications
● Past medical History
● Last meal
● Events and environment related to
injury
MECHANISM OF
BLUNT
INJURYTRAUMA
● MORE energy is transferred over a
wider area
○ associated with multiple widely
distributed injuries
○ organs that cannot yield to impact by
elastic deformation are most likely to
be injured (liver, spleen, and kidneys)
MECHANISM OF
PENETRATING WOUND
INJURY
● LESS energy is transferred over a wider area
○ the damage is localized to the
path of the bullet or knife
○ organs with the largest surface area
are most prone to injury (small bowel,
liver, and colon)
■ Because bullets and knives usually follow
straight lines, adjacent structures are
commonly injured.
NECK INJURIES
TRAUMA TO CHEST AND
THORAX TENSION
PNEUMOTHORAX
Respiratory Distress and Hypotension
+
● Tracheal deviation away from the
affected side
● Lack of or ↓ breath sounds on the
affected side
● Subcutaneous emphysema on the
affected side
TRAUMA TO CHEST AND
THORAXOPEN PNEUMOTHORAX
Full thickness loss of chest wall, permitting free
communication between the pleural space and
atmosphere
Treatment
Initial: Temporary occlusion of wound at its 3
sides Definitive: Closure of the chest wall
defect and closed tube thoracostomy remote
from the wound
TRAUMA TO CHEST AND
THORAX FLAIL CHEST
● 3 or more contiguous ribs are fractured in
at least 2 locations
● Paradoxical movement
Treatment:
○ Presumptive intubation and mechanical
ventilation
TRAUMA TO CHEST AND
THORAX
MAJOR AIR LEAK DUE TO
TRACHEOBRONCHIAL INJURY
Type 1:
● within 2 cm of carina
Type 2:
● Almost always accompanied by
pneumothorax
Diagnosis and Management:
● Directed by Bronchoscopy
DIAGNOSTICS TO THE
CHEST
COMMON TREATMENT FOR CHEST
MODALITIES
TRAUMA TO
BLUNT ABDOMINAL
ABDOMEN
TRAUMA
DIAGNOSTI
DIAGNOSTIC PERITONEAL
CS
LAVAGE
FAS
T
● Sensitive for detecting intraperitoneal fluid
○ >250 mL fluid
● Detects fluid in pericardial sac and
dependent abdominal regions
● Morrison pouch
● LUQ behind the spleen and between the
spleen and kidney
● Pelvic cul de sac (Douglas pouch)
INDICATIONS FOR
LAPAROTOMY
EXPLORATORY
IN PENETRATING OR
BLUNT ABDOMINAL INJURY
● Hemodynamic Instability
● Peritonitis
● Evisceration
● Positive DPL
● Persistent drop in hematocrit
THAN
KYO
U
