Transcript Slide 1

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…..)
Collar application
A & C ;patency
A & C ;FB
A & C ;airways
A&C
NASO
ORO
A & C ; Laryngeal mask
A & C;Tracheal Intubation
A & C; Surgical Cricothyroidotomy
A & C; Needle Cricothyroidotomy
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
B
End-tidal CO2
Qualitative
Quantitative
Haemothorax
Management
 Chest tube
 Indication of surgery
1500 ml once
200 ml/h
Flail chest
Flail chest
Management
 Stabilization
 Observation
 Mechanical ventilation
Pneumothorax
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 ; compession
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
Classes of Shock
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
Revised trauma score
Number
Glasgow
Systolic
pressure
Respiratory
rate
4
13 -15
> 89
10 - 29
3
9 - 12
76 - 89
> 29
2
6-8
50 - 75
6-9
1
4-5
1 - 49
1-5
0
3
0
0
‫تعليمات الوقاية من الكزاز‬
‫نمط‬
‫الجرح‬
‫التمنيع غير معروف < ‪ 5‬سنة من ‪ 10-5‬سنة‬
‫اخر لقاح‬
‫< ‪ 3‬جرعات‬
‫نظيف‬
‫صغير‬
‫ال شيئ‬
‫ال شيئ‬
‫ذوفان الكزاز‬
‫ال شيئ‬
‫ذوفان الكزاز‬
‫ذوفان الكزاز‬
‫ذيفان الكزاز‬
‫غلوبولين مناعي ‪+‬‬
‫باقي‬
‫الجروح ذوفان الكزاز‬
‫> ‪ 10‬سنة‬
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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
‫ مؤيد كاظم‬.‫د‬