management polytrauma
TRANSCRIPT
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Management Of Polytrauma
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Polytrauma ?
• Single patient with multiple injuries ?
• Multiple patients with multiple injuries ?
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Poly = Multi Trauma
• Head Injury
• Chest Injury
• Abdominal Injury
• Skeletal Injury : Limb + Pelvis
• Spine Injury
• Urogenital Injury
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Key Factors
• Team Approach• Triage• Damage control Orthopaedics
• Pre Hosp Care• Primary Survery• Secondary Survey
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• Pre hospital care: EMT
• A & E : Resuscitation
• Specific management
• Nutritional support
• Rehabilitation
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Assessment
• Primary Survey
• Airway
• Breathing
• Circulation
• Disability: Head Injury
• Estimate ISS
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Prim Survey & Resus : Simultaneous
? Find the cause of haemodynamic/resp instability
- Quick short relevant history- Mech of Injury- Level of consciousness- Any CPR instituted- Restore Volume, Ventillation, - Pharmacologic Support
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Secondary Survey
• Head to toe evaluation
• History
• X rays: CXR, Pelvis, Cervical Spine
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Mx Stages( Tscherne)
• Acute care: upto 3 hrs
• Primary Stabilization period : 1 hrs to 3 days
• Secondary Stabilisation 3 to 8 day
• Tertiary Stabilisation: > 8 days
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Acute Care
• A,B,C, D• Chest drain Vs thoracotomy > 1.5 L• Laprotomy r/o pelvic injury• External immobilization:• Open fracure Mx• Perineal wound ??? Colostomy• C spine injury: Immobilize
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Prim Stabilsation
• Adeq perfusion• Steroid ??? Spinal injury• Ix : MRI Vs CT• Pelvic stabilisation : Ex Fix• Limb stabilisation: Ex Fix Vs Nailing• Compartment Release• Open fracture Rx
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• Second Look Debridement
• Flap Cover
• Closed Limb fracture :
LL> UL
Pelvis + LL
UL delayed
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Secondary Stabilisation
• Intra articular resconstruction
• Complex spinal and limb fracrure treatment
• Definitive flaps
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Teritiary Stabilization
• Amputation cover etc
• Reconstructive surgery
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Damage control concept
• IL 6 > SIRS !!!!!!!
• Plan and stage Rx
• Evolved from abdominal injury studies
• Reduce the damage due to surgery
• Imp in Thoraic injury, ARDS, Long bone fracture
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Airway
• Effort
• Excursion
• Effect
• Sounds
Obstruction : In Vs Out
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Breathing
• Pneumothorax : Open, Tension , Flail
• Massive Haemothorax
• Asess ???
Should you wait for an X ray ???
When ICD ?
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Circulation
• BP, HR , UO, Skin, Cyanosis• Volume replace ??? How • When blood ???
Thrombocytopaenia ??? Cardiac tamponade ? Becks Triad : Venous High Decrease Ar Pressure Muffled HS
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Head Injury
• GCS
• ISS
• Coma ?
• Neurogenic Shock Vs Hypovolaemic shock
• Spinal shock
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Abdomen
• Clinical signs
• USG Vs CT Vs DPL
• Laprotomy
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Spine
• Immobilise
• Asso injuries
• Steroids
• X ray : MRI : CT
• Disloc/ Fracture : Reduction
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Pelvis
• See for H hage Stability Dislocation HypothermiaAcidosisCoagulopathy
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Limb Injury
• Open Vs Closed
• LL Vs UL
• Pul injury Vs No lung injury
• Vascular injuries
• Compartments
• Stabilisation