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    Management of Trauma Patients

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    Ahmed Shehata
    1) The document discusses the management of trauma patients according to ATLS (Advanced Trauma Life Support) protocol, beginning with the primary and secondary survey. 2) Injury management includes clinical and radiological assessment, as well as care in the ER such as splinting. Damage control orthopedics (DCO) may be used to avoid adding stress until the patient is stable. 3) Definitive treatment options include conservative treatment or operative treatment, either early or delayed depending on the patient's condition.

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    Management of Trauma Patients

    Uploaded by

    Ahmed Shehata
    155 views4 pages
    1) The document discusses the management of trauma patients according to ATLS (Advanced Trauma Life Support) protocol, beginning with the primary and secondary survey. 2) Injury management includes clinical and radiological assessment, as well as care in the ER such as splinting. Damage control orthopedics (DCO) may be used to avoid adding stress until the patient is stable. 3) Definitive treatment options include conservative treatment or operative treatment, either early or delayed depending on the patient's condition.

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    1) The document discusses the management of trauma patients according to ATLS (Advanced Trauma Life Support) protocol, beginning with the primary and secondary survey. 2) Injury management includes clinical and radiological assessment, as well as care in the ER such as splinting. Damage control orthopedics (DCO) may be used to avoid adding stress until the patient is stable. 3) Definitive treatment options include conservative treatment or operative treatment, either early or delayed depending on the patient's condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    155 views4 pages

    Management of Trauma Patients

    Uploaded by

    Ahmed Shehata
    1) The document discusses the management of trauma patients according to ATLS (Advanced Trauma Life Support) protocol, beginning with the primary and secondary survey. 2) Injury management includes clinical and radiological assessment, as well as care in the ER such as splinting. Damage control orthopedics (DCO) may be used to avoid adding stress until the patient is stable. 3) Definitive treatment options include conservative treatment or operative treatment, either early or delayed depending on the patient's condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Management

    of Trauma Patients

    Management of Trauma Patients


    You should consider ATLS (Advanced Trauma Life Support) protocol
    when discussing management of any fracture or injury as if it is a result
    of high energy trauma until proved otherwise.

    Primary Survey
    Brief history: Name, Age, Time & mechanism of injury
    A Airway • Suction: for removal of blood / vomitus / foreign
    bodies
    • Open by chin lift / jaw thrust with care to possible
    CS injury
    • Application of airway / intubation if needed
    B Breathing • Supplemental oxygen
    • Pulse oximetry: to monitor adequate oxygenation
    • Assess RR
    • Chest examination
    • ABG
    C Circulation • Control external hemorrhage by compression
    • Monitoring of BP, Pulse
    • 2 large bores cannulas
    • Fluid administration: initial volume
    • Blood samples: for labs , blood group matching
    • Management of hypovolemic shock by crystalloids
    or colloids according to degree
    • CPR if cardiac arrest
    D Disability • AVPU assessment:
    A: Alert
    V: responsive to Vocal stimuli
    P: responsive to Painful stimuli
    U: Unresponsive
    E Exposure • Temperature assessment
    • Removal of clothes
    • Warming
    DR. MAHMOUD DESOUKY 1

    Management of Trauma Patients

    F Foley’s catheter • Foley’s catheter to monitor urinary output


    & others • Nasogastric tube
    • Detailed history
    v Allergies
    v Diseases
    v Event of trauma
    v Last meal
    v Medications

    Secondary Survey
    ISS = Injury Severity Scale
    Assessment of 9 regions giving each region AIS = Abbreviated Injury Scale (0 : 6)
    Regions AIS
    1) Head 0 Free
    2) Face 1 Minor injury
    3) Neck 2 Moderate injury
    4) Chest 3 Major injury
    5) Abdomen 4 Life threatening injury
    6) Spine 5 Critical injury
    7) ULs
    8) LLs 6 Fatal injury
    9) Skin
    ISS = sum of squares for the 3 highest AIS grades
    = A2 + B2 + C2

    Injury Management
    I. Clinical assessment
    • Localized tenderness
    • Edema
    • Deformity
    • Limited range of motion
    • Crepitus
    • Ecchymosis, bruising, wounds
    • NV assessment

    DR. MAHMOUD DESOUKY 2



    Management of Trauma Patients

    II. Radiological assessment


    X-rays Trauma survey • CS, DS, LSS lateral view
    • Pelvis AP view
    Injury • 2 perpendicular views
    • Including joint above & joint below
    • Special views
    Other imaging modalities • e.g. CT / MRI , …….

    III. Care in ER: = splinting


    N.B. Special situations
    A. Open fractures
    • Control hemorrhage if present
    • Wound assessment, wash & sterile dressing
    • Initiate parenteral antibiotics +/- tetanus prophylaxis
    • Splinting of fracture
    • Preparation for emergent surgical debridement
    B. Fracture pelvis with hemodynamic instability: pelvic sheet or binder
    C. Fracture spine + incomplete neurology < 8 hours Ò
    Methylprednisolone:
    a) Loading dose 30 mg/kg over 1st hour
    b) Drip 5.4 mg/kg/ hour drip
    - For 23 hours if started < 3 hours after injury
    - For 47 hours if started 3-8 hours after injury

    IV. DCO = Damage Control Orthopedics


    • Assessment of patients for possible staging of management to avoid
    adding stressed to patients in vulnerable period (2nd hit phenomenon)
    a. Stable → total definitive fracture ttt
    b. Unstable → DCO (splinting / external fixators) until safe, then
    proceed to definitive ttt after 7:10 days
    c. In extremis → Splinting + transfer to ICU
    • Parameters of instability:
    1) ISS > 40 (without thoracic trauma)
    2) ISS > 20 with thoracic trauma

    DR. MAHMOUD DESOUKY 3



    Management of Trauma Patients

    3) GCS of 8 or below
    4) Multiple injuries with severe pelvic/abdominal trauma and
    hemorrhagic shock
    5) Bilateral femoral fractures
    6) Pulmonary contusion noted on radiographs
    7) Hypothermia < 35 degrees C
    8) Head injury with AIS of 3 or greater
    9) IL-6 values above 500 pg/dL
    • Exceptions:
    a. Compartment $
    b. Dislocations
    c. Unstable spine fractures
    d. Fracture pelvis with hemodynamically instability
    e. Debridement of wounds in open fractures

    V. Definitive treatment
    • Conservative ttt
    • Operative ttt
    a. Early operative intervention
    b. Delayed operative intervention

    DR. MAHMOUD DESOUKY 4

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