Critically injured patient

Prof Mohan de Silva

Essential words to remember

• TRIMODAL distribution of deaths

• ATLS

• Primary survey

• Secondary survey

The Critically Injured

Trauma

commonest cause of hospital admissions

in Sri Lanka since 1995

commonest cause of death below the

age of 40 in many countries

The critically injured

Majority died due to inadequate treatment

Initial treatment determines the outcome

Early intervention is essential

GOLDEN HOUR OF TRAUMA

TRIMODAL DISTRIBUTION OF DEATHS

• Immediate

• 1st few hours

• Few days after admission

Conventional approach

History

Examination

Investigations

Diagnosis

Treatment

How it all started

Another accident ………..

Initial assessment ( History,

Examination )

Resuscitation ( Treatment )

WILL BEGIN SIMALTANEOUSLY

Recognize and treat the most life

threatening injury first

New approach… A T L S

Acute airway obstruction - The quickest killer Inadequate breathing

Hypovolaemia

Expanding intra cranial haematoma

TRAUMA KILLS ACCORDING TO A

SEQUENCE !

Hypoxia and Hypovolaemia

are the main killers

Hypoxia kills before

hypovolaemia

PRIMARY SURVEY

SECONDARY SURVEY

Initial assessment and resuscitation

Primary survey

A ir way with cervical spine control

B reathing C irculation D isability (Neurological ) E xposure F oleys catheter

Airway obstruction recognition and treatment

Identify – SPEAK TO THE PATIENT

establish OXYGEN

protect OXYGEN

maintain OXYGEN

10 L / minute

Immobilisation of the C spine

sand bag

collar

tape

B reathing Inspection - wall movements,ext. injuries etc

Palpation - cripitus

percussion - hyperesonence or stony dullness

Auscultation - breath sounds absent RESPIRATORY RATE

Circulation

All critically injured patients are in hypovolaemic shock

Action

PULSE RATE , B P

2 Big drips to Two big veins

2 L of N Saline fast in

Blood cross matching

A V P U

Glasgow coma score

Expose the patient Where is the scissor !

D isability (Neurological )

Secondary survey

Systematic examination from head

to toe

LOG ROLL

Finger to all orifices

Minor injuries

Pulse - BP – RR -Temperature

History

A M P L E

A llergies

M edications

P ast illnesses

L ast meal

E vents leading to the injury

Outcome

• ?• ?• ?

TAKE HOME MESSAGE

What is the first thing you do when you get a

critically injured ?

What is the quickest killer of the injured?

What is trimodal distribution of deaths?

What is the difference between conventional and

ATLS approach

What do you do in Primary and secondary

surveys?