1. PRINCIPLES OF TRAUMA CARE CELSO M. FIDEL, MD, FPCS, FPSGS Diplomate Philippine Board of Surgery

2. LOVE your CALLING with PASSION . It is the MEANING of your LIFE Rodin

4. Vehicular Accident

5. Smash up Cars

6. Truck involved in the Mishap

7. On the spot reporting

11. A, B, C’s of Basic Life Support

13. AIRWAY PATENCY

16. REMOVAL of FOREIGN BODIES

19. Methods of Opening Airway

22. Feeling for Breathing

25. Mouth to Mouth Resuscitation

29. CIRCULATION

33. CARDIOPULMONARY RESUSCITATION

35. Primary Survey  Check Pupils  size; evidence of inequality  reaction  response to light  Sensory- can feel in all parts of body?  Motor- can move all limbs?

36. WHEN TO TRANSFER TO TRAUMA CENTER? TRAUMA SCORING  For appropriate Triage  Hospital Transfer  Assurance of quality Care  PEDIATRIC TRAUMA SCALE  Size  Airway  Systolic Blood Pressure > 20 kgs +2 10-20 kgs +1 < 10 kgs 1 NORMAL +2 MAINTAINABLE +1 NOT MAINTAINABLE -1 > 90 mm Hg +2 50-90 mm Hg +1 < than 50 mm Hg -1

42. SECONDARY SURVEY  What are the Important points in the HISTORY of TRAUMA VICTIMS? Systematic Evaluation  S- Signs and symptoms  A- Allergies  M- Medications taken  P- Pertinent History  L- Last meal taken  E- Events preceeding the injury

43. SECONDARY SURVEY Physical Examinations Look for signs of injury  D- Deformities  O- Open injuries  T- Tenderness  S- Swelling

44. SECONDARY SURVEY Physical Examinations –Head to Toe  Examination of the Head A. Scalp and Skull ;Look for signs of injury  D- Deformities  O- Open injuries  T- Tenderness  S- Swelling

45. SECONDARY SURVEY A. Scalp and Skull  Brisk bleeding= rapid suture closure  Nasopharyngeal bleeding= French 20 foley catheter  Ecchymosis about the ear ( battle sign ); or about the eyes ( raccoon eyes )= presumptive evidence of BASAL SKULL FRACTURE

46. SECONDARY SURVEY B. Pupils  Symmetry  Reactivity  Size C. Ears and Nose  Blood or Fluid from opening

47. SECONDARY SURVEY D. Mouth D- Deformities O- Open Injuries T- Tenderness S- Swelling F- Foreign Bodies

48. SECONDARY SURVEY A. Examination of the Neck D- Deformities O- Open Injuries T- Tenderness S- Swelling B. Cervical Vertebrae  Deformities  Palpate for step-up Deformities

49. SECONDARY SURVEY  Examination of the Chest ; Check for  Symmetry of Expansion  Breath Sounds  Abrasions  Subcutaneous Emphysema  Open Wounds  Rib or Clavicular Fracture

50. SECONDARY SURVEY  Examination of the Abdomen A. Inspection Deformities; Abdominal Distension Open Injuries Protruding Organs Swelling & Discoloration

51. SECONDARY SURVEY B. Palpation  Rigidity ( Hardness)  Tenderness  Masses C. Auscultation  Listen for bowel sounds

52. SECONDARY SURVEY  Diagnostic Aids for the Abdomen  Diagnostic Peritoneal Lavage for suspected blunt injury  One shot IVP if GU injury is suspected  A Cystogram may be done by clamping the catheter  CT scan if accessible and available can be done on stable patients

54. SECONDARY SURVEY  Examination of the Pelvis and Rectum  Check for scrotal hematoma  Check for blood in the urethral meatus  Check for a high lying prostate  Blood on rectal exams may indicate injury to the rectum or neighboring organs  Blood in the vagina vault or introitus may indicate pelvic fracture

55. SECONDARY SURVEY  Examination of the Back A. Inspection  Chest Wall deformities  Open Injuries  Foreign Objects  Dislocation B. Palpation  Palpate for deformities along spine  Tenderness

56. SECONDARY SURVEY  Examine Upper & Lower Extremities A. Inspection >> Deformities, Open injuries, Swelling >> Color >> Motion, Wiggle test >> Sensation B. Palpation >> Tenderness >> Crepitation >> Deformities

57. SECONDARY SURVEY  Measuring Vital Signs 1. Respiration 2. Pulse Rate 3. Blood Pressure Increased BP Decreased BP 1. Cold environment 1. Heart failure 2. Stress; Pain 2. Trauma 3. Smoking 3. Shock 4. Caffeine 5. Decongestant

58. SECONDARY SURVEY  Pupils Normal Findings Abnormal Findings > constricts when >> No reaction to exposed to sun- light light >> R emains constric ted >Dilate with less >> Fixed, dilated or light unequal >Should be of the same size

59. SECONDARY SURVEY ESSENTIAL LAB. PROCEDURES  Baseline Hematocrit, Blood Typing, and Cross Matching.  A cross table x-Ray of the cervical spine w/o the victim being hyperextended. “Swimmer’s” view if not possible; x-Ray tube positioned at axilla directed to C-7. It will view lower Cervical vertebra and T1.

60. SECONDARY SURVEY WHERE and HOW do WE LOOK for Blood Loss?  There are three sites for exsanguinating hemorrhage:  CHEST  ABDOMEN  THIGH (2-3 liters of blood in Hematoma)

61. SECONDARY SURVEY  Patients with injury to these sites; Thoracic is 1 st followed by Abdomen then extremities. Control of life threatening activities takes precedence over limb salvage.  Chest x-Ray important especially looking for sites of blood loss .

67. Other concerns in care of Casualties  Adequately Immunized Patients A. Last dose w/in 5 years>>> All Wounds >> NONE B. Last dose w/in 10 years:  Non Tetanus prone wound>>> NONE  Tetanus prone Wound>>>> Toxoid C. Last dose > 10 years >> All Wounds >>> Toxoid  Inadequately Immunized Patients  Non Tetanus Prone Wound>>>> Toxoid  Tetanus prone Wound>>>Toxoid and Antitoxin  after one to 12 months>> Toxoid

79. BLEEDING FLOW CHART 1.LOCATE BLEEDING SITE 2. APPLY DIRECT PRESSURE ON THE WOUND BLEEDING STOPPED ? 3. ELEVATE EXTREMITY ABOVE CASUALTY’s HEART 5. TREAT FOR SHOCK CARE FOR WOUND SEEK MEDICAL ATTENTION BLEEDING STOPPED? 4. LOCATE PRESSURE POINTS & APPLY PRESSURE; KEEP PRESSURE OVER WOUNDS TREAT SHOCK BLEEDING STOPPED? BLEEDING FROM ARM OR LEG 6. APPLY TOURNIQUE AS LAST RESORT 7. SEEK MEDICAL ATTENTION NO YES YES NO YES NO NO YES

80. HEAD INJURIES 1. CHECK ABC’s & TREAT ACORDINGLY 2. CHECK FOR POSSIBLE SPINAL INJURY IMMOBILIZE HEAD AND NECK HEAD BLEEDING 3. DIRECT PRESSURE OVER THE WOUND. If FRACTURE SUSPECTED APPLY PRESSURE TO OUTER EDGES OF THE INTACT BONE 4. DO NOT REMOVE IMPALED OBJECTS UNCONSCIOUS 5. RAISE VICTIMS HEAD& SHOULDERS IF NO SPINAL INJURY & NOT IN SHOCK 6 KEEP PATIENT LYING ON THE GROUND 7. SEEK IMMEDIATE MEDICAL ATTENTION IF W/ SIGNS OF POSSIBLE BRAIN INJURY YES NO NO YES

81. ABDOMINAL INJURIES Flow Chart 1.CHECK ABCs and TREAT ACCORDINGLY PENETRATING WOUNDS IMPALED OBJECTS PROTRUDING ORGANS ? 2. DO NOT REMOVE OBJECT Stabilize subject 3. DO NOT RE-INSERT ORGAN DO NOT TOUCH ORGAN COVER W/ MOIST CLEAN DRESSING BLOW TO ABDOMEN ? 4. ROLL VICTIM TO ONE SIDE IN CASE OF VOMITING 5. SEEK MEDICAL ATTENTION YES NO NO YES NO YES

87. CHEST INJURIES Flow Chart CHECK ABC’s and TREAT ACCORDINGLY PENETRATING WOUNDS IMPALED OBJECTS SUCKING CHEST WOUNDS DO NOT REMOVE OBJECT Stabilize subject SEAL WOUND TO PREVEN T AIR TO ENTER RIB FRACTURE 4. STABILIZE RIBS and CHEST 5.SEEK MEDICAL ATTENTION YES NO NO YES YES NO

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