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ABCs Evaluation of Trauma Patient. By Dr. Mahmoud Shehadah Al hariri Emergency Medicine Orthopedic surgery. Primary Survey. A irway & C -spine B reathing C irculation E xposure D isability . Secondary Survey . Mechanism of the injury Systemic evaluation Definitive treatment.
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ABCs Evaluation of Trauma Patient By Dr. Mahmoud Shehadah Al hariri Emergency Medicine Orthopedic surgery
Primary Survey • Airway & C-spine • Breathing • Circulation • Exposure • Disability
Secondary Survey • Mechanism of the injury • Systemic evaluation • Definitive treatment
Airway and C-spine control Assessment • Ascertain patency • Immobilization of C-spine ; hard collar sand bags tape
A & C Management • Chin lift Vs jaw thrust • Clear the airway of foreign bodies • Oropharyngeal or nasopharyngeal airways • Definitive airway ( intubation, LMV, Cricothyroidotomy…..)
A & C NASO ORO
Breathing Assessment • Expose the neck and chest • Rate and depth of respiration • Inspect and palpate the neck and chest • Percuss the chest • Osculate the chest bilaterally
B Management • Administer high concentrations oxygen • Ventilate with a bag-valve-mask or face-mask • Attach an end-tidal CO2 and pulse oximetery Attention to; • Alleviate tension pneumothorax • Seal open pneumothorax • Flail chest
End-tidal CO2 Qualitative Quantitative
Haemothorax Management • Chest tube • Indication of surgery 1500 ml once 200 ml/h
Flail chest Management • Stabilization • Observation • Mechanical ventilation
Pneumothorax Management • Simple ; observe • Tension ; needle insertion chest tube 3-side patch (for 0pen,sucking)
Circulation Assessment • Pulse: presence, quality, rate, regularity, paradox • Identify source of external hemorrhage • Skin color ( extremities ) • Blood pressure ( shock )
C Management • Direct pressure to external bleeding site • Insert two large-caliber intravenous catheters • Obtain blood for Labs; Hct , cross-match and ABGs • Start rapid IV fluid ( RL , NS ) • Pneumatic splints or PASG to control hemorrhage • ECG monitor
Traumatic Types of Shock • Hypovolemic ( low CVP ) • Cardiogenic ( high CVP ) • Neurogenic ( low HR )
Disability Assessment • Determine the level of consciousness using AVPU • Assess the pupils for size, equality and reaction
Exposure • Completely undress the patient • Prevent hypothermia
MoKazem.com • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. • الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. • This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali. • This site is not responsible of any mistake may exist in this lecture. Dr. Muayad Kadhim د. مؤيد كاظم