29 - dicker - trauma case presentations
DESCRIPTION
hdtiTRANSCRIPT
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Trauma Case Trauma Case PresentationsPresentations
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Case #1Case #1EMS Report:EMS Report: 26 year26 year--old man shot multiple timesold man shot multiple times Vomited with probable aspiration en routeVomited with probable aspiration en route Vitals upon arrival to trauma bayVitals upon arrival to trauma bay
90/P, HR 120, RR 3090/P, HR 120, RR 30
WorkupWorkup--Primary surveyPrimary surveyAirway intactAirway intactDistant but audible bilateral breath soundsDistant but audible bilateral breath soundsSecond vitals: 85/P, HR 120, RR 30Second vitals: 85/P, HR 120, RR 30ABG: 7.25/30/120/ ABG: 7.25/30/120/ --1414
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Case #1: Secondary surveyCase #1: Secondary survey
Lethargic but arousableLethargic but arousableGun shot wounds as Gun shot wounds as shownshownMoves all extremitiesMoves all extremitiesBleeding from GSW at Bleeding from GSW at inguinal ligamentinguinal ligamentPulseless RLEPulseless RLE
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Case #1Case #1--ManagementManagement
AirwayAirwayIV accessIV accessRadiologic studiesRadiologic studiesBlood workBlood workNext set of vitals: 70/P, HR 140, RR 30Next set of vitals: 70/P, HR 140, RR 30Resuscitation Resuscitation
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Radiologic studiesRadiologic studies
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Operative ManagementOperative Management
First incisionFirst incision Operative proceedings and findingsOperative proceedings and findings Resuscitation; blood product ratiosResuscitation; blood product ratios Antibiotics ?Antibiotics ?Next moveNext move How to manage the How to manage the poplitealpopliteal OrthopedicOrthopedicss rolerole
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ICU ManagementICU ManagementSedation and ventilation in a patient with Sedation and ventilation in a patient with an open abdomenan open abdomenTiming of operative returnTiming of operative return
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Second OperationSecond Operation
Management from AnesthesiaManagement from Anesthesia
Management from SurgeryManagement from Surgery
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Follow up careFollow up care
CKCK--40,00040,000 Workup and managementWorkup and management
RLE vascular imaging choicesRLE vascular imaging choices
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Case #2Case #2EMS report: 74 yearEMS report: 74 year--old driver in highold driver in high--speed speed MVCMVC Belted, no airbag, + LOCBelted, no airbag, + LOC
Upon arrival to trauma bay:Upon arrival to trauma bay: Vitals 130/P, Vitals 130/P, afibafib 100, RR 30100, RR 30 ABGABG--7.34/42/80 BD7.34/42/80 BD--55
Primary surveyPrimary survey Airway; tongue dropping backAirway; tongue dropping back Shallow breath sounds R>LShallow breath sounds R>L AccessAccess GCSGCS--55
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RadiologyRadiology
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ManagementManagement
ResuscitationResuscitationNext stepsNext steps..
Chest tube placed, intubationChest tube placed, intubation
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Head CTHead CT
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Chest CTChest CT
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Operative Management:Operative Management: Subdural evacuationSubdural evacuation
Anesthesia PrinciplesAnesthesia Principles
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Management of Traumatic Aortic Management of Traumatic Aortic LacerationLaceration
Endovascular Options?Endovascular Options?In setting of head injury?In setting of head injury? Issues with anticoagulationIssues with anticoagulationICU CareICU Care Glucose control with head injuryGlucose control with head injury Rate control for Rate control for afibafib PreopPreop care to limit shear effect of injurycare to limit shear effect of injury
Trauma Case PresentationsCase #1Case #1: Secondary surveyCase #1-ManagementRadiologic studiesOperative ManagementICU ManagementSecond OperationFollow up careCase #2RadiologyManagementHead CTChest CTOperative Management: Subdural evacuationManagement of Traumatic Aortic Laceration