TRAUMA MULTIPLE INJURY

1. TRAUMA & MULTIPLE INJURY

2. INJURY BIOMECHANICS AND ACCIDENT PREVENTION The magnitude of an injury is related to energy transferred to the victim during the event, the volume/area of tissue involved and the time taken for the interaction

3. ALCOHOL & DRUGS TRAUMA DUE TO ALCOHOL IN ASSAULTS – 60% BURNS HOMICIDES DROWNING ROAD TRAFFIC ACCIDENT – 10% DEATH DUE TO ALCOHOL IN RTA- 1/3 OF DEATH (30%) DEATH DUE TO ALCOHOL IN RTA- 20%

4. WOUNDS CLASSIFICATION ABRASION OR GRAZES CONTUSIONS , ECCHYMOSES OR BRUISES LACERATIONS INCISED WOUNDS / CUTS PUNCTURE WOUNDS GUNSHOT WOUNDS

5. FALLS Major determinant of injury and the chance of death is directly proportional to the height fallen. At impact the decelerating forces are determined by the individual’s mass , the nature of the landing surface and the body’s orientation on landing

6. INJURY SEVERITY ASSESSMENT Abbreviated Injury Scale (A.I.S) – Severity of Anatomical injury Glasgow Coma Scale (G.C.S) – Assess the neurological state of mind GCS + Systolic B.P + Respiratory rate -----? Revised Trauma Score

7. Eye opening Spontaneously 4 to speech 3 to pain 2 none 1 Verbal Response Orientated 5 Confused 4 inappropriate words 3 incomprehensible sounds 2 none 1 Motor Response Obey commands 6 Localizes to pain 5 Flexion(withdraw)to pain 4 Abnormal flexion to pain 3 Extension to pain 2 None 1 - Total /15

8. ASSESSING MUSCLE POWER- the MRC scale No flicker movement 0 A flicker of contraction,but no movement 1 Movement, with gravity neutralized 2 Movement against gravity 3 Movement against added resistance 4 Normal power 5

9. IMAGING & OTHER DIAGNOSTIC AIDS INITIAL X RAYS CHEST CERVICAL SPINE PELVIS THORACIC / LUMBAR VIEWS FOR HEAD,SPINAL AND PELVIC INJURY - CT SCAN SKULL X RAY

10. AFTER THE RESUSCITATION ROOM Immediate aim of resuscitation is to assess & treat life threatening injuries Patient with Patent Airways Adequate Gas Exchange Circulatory Status is normail Long Bone Fractures Splinted Cervical Spine Control maintained throughout Identify the correct destination for the patient Perform Surgical Intervention if needed Full Monitoring & Resuscitation Equipment mandatory if to be transferred to theatre If to be transferred to another Hospital should be done appropriately Regular updates should be supplied to the receiving specilalists.

11. PREHOSPITAL CARE & TRANSPORT AMBULANCE SERVICES (land based vehicles, Helicopters , fixed wing air craft) PARAMEDICS

12. RESUSCITATION IN THE A&E DEPARTMENT FIRST 10 MINUTES ------------------------- AIRWAY CONTROL OF CERVICAL SPINE ADVANCED AIRWAY TECHNIQUES BREATHING CIRCULATION ANALGESIA & SPLINTING NEXT PHASE ------------------ PATIENT EXAMINED FROM TOP TO TOE BACK & SPINE ARE EXAMINED LOOKING FOR LOCALISED TENDERNESS/SWELLING / OR A ‘STEP’ PERINEUM IS EXAMINED RECTAL EXAMINATION IS PERFORMED NEUROLOGICAL EXAMINATION EXAMINE FOR EVIDENCE OF SKULL BASE INJURY MUSCLE POWER TESTED USING MRC SCALE TENDON REFLEXES EXAMINED

13. TRAUMA&MULTIPLE INJURY Clinical Scenarios

14. 1) A 38 year old woman is hit over the head with an iron bar. She opens her eyes to speech and talks in a lucid manner. She moves her limbs spontaneously. Select the appropriate Glasgow Coma Scale? Discuss the management?

15. 2)A 16 year old boy falls of some scaffolding and lands on his head. On arrival to the Accident and Emergency Department he opens his eyes to pain and makes only grunting noises. He withdraws his limbs his limbs from painful stimuli Select the appropriate Glasgow Coma Scale? Discuss the management?

16. 3) A 46 year old man is involved in a high-speed road traffic accident in which he is thrown from the car .He opens his eyes to speech and localizes painful stimuli. He can speak but his sentences sound confused Select the appropriate Glasgow Coma Scale? Discuss the management?