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Advanced Trauma Life Support An Introduction to management of the trauma patient

Advanced Trauma Life Support An Introduction to management of the trauma patient

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Advanced Trauma Life Support An Introduction to management of the trauma patient

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  1. Advanced Trauma Life SupportAn Introduction to management of the trauma patient Rob Simpson Acute Block Teaching

  2. The Pre-hospital phase • Good Trauma Care starts at the road side • Moving towards hub and spoke model in the UK

  3. Trauma Resuscitation • Preparation (call for senior help!!) • Primary Survey (cA&cBCDE) • Resuscitation / Adjuncts to primary survey • Secondary Survey (head-to-toe) • Continued monitoring and re-evaluation • Definitive Care

  4. Preparation • Assemble team • Prepare equipment • Delegate tasks • MIST handover

  5. Airway Primary survey Lines and bloods Radiographer / radiology Scribe Specialty opinions “The trauma team”

  6. Arrival of the patient • MIST handover • M Mechanism of injury • I Injuries Identified • S Vital signs • T Treatment & timings

  7. Control of massive haemmorhage • Stepwise process • Direct pressure • Elevation • Tourniquet

  8. Assessment Look & listen Airway

  9. Airway with cervical spine control • Manual in-line immobilization • Collar, blocks & tape • Airway manouvers • Jaw thrust • Simple adjuncts • Advanced airway techniques • High-flow oxygen

  10. Breathing • Rapid assessment • Inspection • Auscultation • Percussion • Palpation • Trachea • crepitus

  11. Immediately life “B” problems • TOM FC

  12. Tension Pneumothorax • Open pneumothorax • Massive haemothorax • Flail segment • Cardiac tamponade

  13. Do you have a confident management plan for each of these ?

  14. Tension pneumothorax • What is it ? • How does it present ? • What is the immediate action ? • What should be done next ?

  15. Open Pneumothorax • What is it ? • Why does it cause a problem ? • What is the immediate management ? • What should be done next ?

  16. Massive haemothorax • What is the definition of a massive haemothorax ? • What is the management ? • Theatre ?

  17. What is the definition ? What is the management? What is the principal concern ? Flail chest

  18. Cardiac tamponade • Suspect if resistant hypotension in the absence of bleeding • What is the definitive investigation? • What is the treatment ?

  19. Circulation • Assessment • Where has it all gone ? Rule of 5 • Basics of trauma resuscitation – not just sea water! • Massive Transfusion protocol

  20. Assessment • Same as any other “c” assessment • but – • control life threatening haemorrhage

  21. Where has it all gone • 1. Chest • 2. Abdomen • 3. Retroperitoneum /pelvis • 4. Limbs • 5. On the floor • Remember losses at scene

  22. Assessung sites of potential blood loss • Chest xray • Pelvic xray • FAST scan • CT scan

  23. Resuscitation • IV lines • Concept of balanced resuscitation • Radial pulse • Mentation • BP • Use blood as first line fluid – or nothing! • MTP • Military model 1:1:1 • CRASH 2 trial

  24. STOP the bleeding! • Compression of active bleeding sites • Early imaging • Early surgical involvement • Splinting of femoral fractures

  25. Disability • Optimisation of ABCs • Careful BP management • Early CT scan • Early involvement of neurosurgeons • Consider head up if isolated head injury

  26. Exposure/environmental control • Fully expose the patient • Assess for other potentially life/limb threating injuries • Cover the patient

  27. Monitoring • Cardiac monitor • pulse oximeter • automated blood pressure • serial blood gases • urine output • Nurses should institute this during the primary survey / resuscitation phase

  28. Analgesia • Makes assessment easier • patient easier to manage • less stressful for staff • intravenous opiate • titrate to effect • remember anti-emetic

  29. Secondary survey • Head to toe examination for as yet undiscovered injuries • X-ray relevant areas if patient stable enough

  30. DEFINITIVE CARE • essential investigations • necessary specialists • stabilization/protection/safe transfer • further investigation/intervention

  31. Questions?

  32. Summary • Robust pre-hospital care • Experienced and effective team leadership • Rapid identification and treatment of life-threatening injuries • Stabilisation and definitive care