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Trauma Overview

Trauma Overview

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Trauma Overview

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  1. Trauma Overview David B. Reedy, M.D., FACEP Contra Costa Regional Medical Center Assistant Clinical Professor UCSF/SFGH

  2. Trauma is an injury caused by a physical force • Motor vehicle collisions • Falls • Gun shot • Stabbing • Burns • Blunt assault

  3. Advanced Trauma Life Support • American College of Surgeons • Provides a framework for the management of the injured patient • Intended to allow the single doctor in a rural hospital to assess and manage trauma patients

  4. ATLS Origins • Nebraska, 1976 • Plane crash in a Nebraska field changed the face of trauma care throughout the world • Medical, EMS, and Nursing groups began to collate protocols for trauma management • ACS publishes ATLS in 1980

  5. Blunt Thoracic Trauma

  6. Blunt Thoracic Trauma • Airway • Look for associated injuries • Remember c-spine

  7. Blunt Thoracic Trauma • Breathing • Respiratory rate • Paradoxical motion • Crepitus • Subcutaneous air • Auscultation

  8. Blunt Thoracic Trauma • CXR-pneumothorax • Tracheal deviation, hypotension, hypoxemia

  9. Blunt Thoracic Trauma • Circulation • Hypotension • Hypovolemia • Pneumothorax • Cardiac tamponade • Aortic Injury • Blunt cardiac injury • Arrhythmia • NSR

  10. Blunt Thoracic Trauma • CXR-widened mediastinum

  11. Blunt Thoracic Trauma • Aortic injury • 80-90% of patients with thoracic aortic rupture die in the pre-hospital setting • Those who survive may have minimal initial symptoms • CXR may be first clue

  12. Penetrating Thoracic Trauma • Emergency Department Thoracotomy • “The surgeon who should attempt to suture a wound of the heart would lose the respect of his surgical colleagues” - Theodore Bilroth, 1882

  13. Penetrating Thoracic Trauma • Emergency Department Thoracotomy

  14. Penetrating Thoracic Trauma • Emergency Department Thoracotomy • Indications • Penetrating thoracic traumatic arrest with previously witnessed cardiac activity • Penetrating thoracic unresponsive hypotension

  15. Penetrating Thoracic Trauma • Emergency Department Thoracotomy

  16. Penetrating Thoracic Trauma • Emergency Department Thoracotomy • Contraindications • Blunt thoracic injuries with no witnessed cardiac activity • Multiple blunt trauma • Severe head injury

  17. Penetrating Thoracic Trauma • Emergency Department Thoracotomy • ACLS algorithms do NOT apply to traumatic arrest

  18. Trauma Ultrasonography • The FAST Exam

  19. Trauma Ultrasonography • Focused Assessment with Sonography for Trauma (FAST) • Limited ultrasound exam • Directed solely at identifying the presence of free intraperitoneal or pericardial fluid • Free fluid is usually due to hemorrhage • Helps determine the need for OR, CT, or angiography

  20. Trauma Ultrasonography • FAST examines four areas for free fluid

  21. Trauma Ultrasonography Low Frequency Probe 2.5 - 5.0 MHz Tissue Penetration

  22. Trauma Ultrasonography • Perihepatic and hepato-renal

  23. Trauma Ultrasonography

  24. Trauma Ultrasonography

  25. Trauma Ultrasonography

  26. Trauma Ultrasonography

  27. Trauma Ultrasonograpy • Spleno-renal

  28. Trauma Ultrasonography

  29. Trauma Ultrasonography

  30. Trauma Ultrasonography • Pelvis

  31. Trauma Ultrasonography

  32. Trauma Ultrasonography

  33. Trauma Ultrasonography • Pericardium

  34. Trauma Ultrasonography

  35. Trauma Ultrasonography • Blunt Abdominal Trauma • Not for bowel injury, solid organ injury, or retroperitoneal injury • Detection of free intraperitoneal or pericardial fluid

  36. Trauma Ultrasonography • EFast Exam • Extended Fast Exam • Anterior lung apices for pneumothorax • Lung bases for pleural fluid

  37. Trauma Ultrasonography

  38. Trauma Ultrasonography

  39. Trauma Ultrasonography • Conclusions • Clinician based ultrasound has changed the way trauma care is practiced and is rapidly becoming standard of care • Noninvasive, straightforward, relatively short training period • Multiple training courses exist • Focused exam, goal specific

  40. ATLS 8th Edition, 2008 30 year anniversary “Best evidence” based (i.e. spinal steroids) Revised pediatric guidelines Disaster management

  41. The Knife and Gun Club