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Trauma

Trauma. Leading cause of death & disability. Till forty. Hassan Ravari MD Associated Professor of Vascular Surgery Mashhad-Imam Reza Hospital Department of vascular surgery. /. No vital signs. No signs of life. A Airway ( cervical spine protection) B Breathing

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Trauma

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  1. Trauma Leading cause of death & disability Till forty Hassan Ravari MD Associated Professor of Vascular Surgery Mashhad-Imam Reza Hospital Department of vascular surgery

  2. / No vital signs No signs of life

  3. A Airway ( cervical spine protection) • B Breathing • C Circulation (control of external - bleeding)

  4. Airway obstruction The leading cause of death at the accident site

  5. Foreign body

  6. Mouth-to-Mouth Ventilation

  7. Endotracheal Intubation GCS < 8 RR > 35/min P O2 < 60 mmHg P CO2 > 50 mmHg

  8. Elective Intubation Extensive neck emphysema Burn of the airway Airway bleeding Expanding neck hematoma

  9. Surgical Cricothyroidotomy

  10. Needle Cricothyroidotomy

  11. Multiple trauma requiring oxygen twice normal

  12. Carotid P. = 60 mmHg Femoral P. = 70 mmHg Radial P. = 80 mmHg

  13. Etiology of shock after trauma: Tension pneumothorax Cardiac tamponade Massive hemothorax Heart contusion

  14. Etiology of shock after trauma: Cont. Air embolism Great vessel inj. Ruptured diaphragm Pulmonary contusion

  15. Cardiac Massage

  16. Shock Position

  17. Tension pneumothorax a clinical diagnosis

  18. Chest pain Dilated neck veins Absent breath sound

  19. Needle aspiration

  20. Ant. A.L Mid. A.L Chest tube

  21. Chest tube

  22. Open pneumothorax Taped on three sides

  23. Tamponade

  24. Pericardiocentesis

  25. IV Line at the scene

  26. Trauma team Leader

  27. Crystalloid or colloid Ringer lactate

  28. Suspicious to internal bleeding (Hypotensive Resuscitation) (Controlled Hypotension)

  29. Blood Ringer 1 lit. bolus ( 20 cc/kg child ) Repeated if needed

  30. Estimated blood loss (Fx) Humerus 0.5-1.5 lit. Tibia 0.5-1.5 lit. Femur 1-2.5 lit. Pelvis 1-4 lit.

  31. Immobilization

  32. Immobilization

  33. All injured patients have spine instability until proved otherwise

  34. Every patient has a Back as well as a Front NG tube Foley catheter

  35. No NG tube: Maxillofascial Fx Base of skull Fx Penet. inj. of the neck Cervical spine Fx

  36. No Urinary catheter: Blood on meatus Scrotal hematoma Perineal hematoma Floating prostate High riding prostate

  37. High-velosity gunshot inj. Almost-always require operation Almost-always require operation

  38. Penetrating injury Neck Back Flank

  39. Concomitant Thoracoabdominal injury

  40. Antibiotic Keflin 1g Q6h IV

  41. Analgesic: Limb Fx Rib Fx

  42. No analgesic: CNS observation

  43. The radiology department is a dangerous place Is the investigation essential ? Is the patient stable ?

  44. X-ray in all major trauma: 1-Cervical spine (lat.) 2-Chest (PA) 3-Pelvis (PA)

  45. Preventing hypothermia : Warm fluids Heating pads Warm environment

  46. Restlessness & confusion is due to Hypoxemia Until proven otherwise

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