PreHospital Management Of Trauma Patients دكتور محمود ابو عبيلة

السلام عليكم
محاضرة
http://www.4shared.com/get/70020962/967a2529/Prehospital_Mx_Of_Trauma_Pts
.html
للدكتور محمود ابو عبيلة
من اعدادي

وهذه المحاضرة بملف صوتي

http://www.4shared.com/file/69889024/967dee9c/_prehospital_mana_of_trauma_pts.html

PreHospital Management Of Trauma Patients

Our Topics are:
-Epidemiology.
-Circumstances of accidents.
-Triage team.
-Primary Survey-ABCDE
-Secondary Survey.
-Definitive care (management)

EPIDEMIOLOGY
Road traffic accidents (RTA) is very common worldwide esp. in our country, that we are talking about 1000 victims \year
And when we add falling down accidents, burns and others, it will reach about 2000 deaths\ year. that's a large num. Comparing to the total population num. In Jordan.
***Those victims are usually young adults .

CIRCUMSTANCES OF ACCIDENTS.
From the circumstances of the accidents, we can predict if the accident is simple or big one. but how?
1- by knowing the speed at which the accident had occurred, for example a speed of 40 mile\hr (60 km\hr)is enough to cause a significant trauma to the front collagen person in RTAs.
2- Other victims in the accident, if other persons was dead, this may indicate that the accident is a big one.
3- Num. Of rolling over كم مرة قلبت فيه السيارة
4- Extraction time out the carالوقت اللي طلعنا فيه المريض خارج السيارة , > 30 minutessevere accident.
( also in falling down,>6ms is severe).
5- Others:نوع السيارة,حزام الامان,أي مقعد قاعد




TRIAGE TEAM
They are the persons firstly see the patient at the accident
( 3-5 persons) مثل الدفاع المدني
-you may be a member of the triage team at a time during your life when you first see the accident.
This team is very important for classification of the patients at the accident to see priorities and how to manage them later on,in the hospital.
What is the job of the triage team ?
1- they make alert for the hospital where the patient will be sent to (calls & arranges)
2- to detect those patients with the most severe injuries(LIFE-THRETENING) to take a priority in management, and to determine to which hospital is to be sent. (classification of the patients -1ry survey –ABCDE)

what are the life-threatening conditions?
-tension pneumothorax.
-open pneumothorax.
-Cardiac tamponade.
-massive bleeding.







PRIMARY SURVEY
Its aim is to detect the life-threatening conditions as soon as possible by the role of ABCDE ( IMPORTANT STATEMENT)
BUT it could be started at the seen of the accident.

A: Airways :can be closed or interrupted by:
-aspiration due to vomiting.
-hematoma –e.g after mandibular or maxillary fracture

B: Breathing : check if the breathing is intact or not, and the most important is to count the respiratory rate, e.g if it was high, this means that the pt is struggling for breathing(in labor)
so he is using the accessory respiratory muscles: sternocledomastoid, intercosrals..etc
and this can lead to resp. muscles fatigueresp. failure.

Breathing is important to prevent hypoxia, so its managed by giving oxygen: mouth to mouth breathing or ambo-bag ….etc

C: Circulation (and controlling hemorrhage)
Is affected by bleeding whether it was external (revealed)
Or internal (concealed)

How to manage the bleeding?
stop bleeding then give I.V fuids.

A bleeding artery is v. dangerous , bcz the person will loose a large amount of blood in a short time( as in cases of suicidal persons, where they try to cut the radial artery to make large bleeding till death!)
You should stop the bleeding quickly by digital pressure (mechanical). you can use a peace of your lap coat as well

Your first aim is to stop bleeding(not to replace it by I.V fluids)
So if the pt could reach the hospital within 20 mins, there is no quick need to start I.V fluids, but more than that, u should start them during the way to the hospital.
But be careful that I.V fluids is not always with good results!
Some times the pressure in the area of bleeding become increased after closing it, and by adding the fluids, the pressure will increase more (compartment effect) and could start bleeding again
vicious cycle
I.V fluids could be:
*crystalloid *colloid * O –ve blood


D: Disability
Trauma pts are liable for head injuries, so you must check the level of consciousness by eye movement- glascow coma scale, if it was below 8, this is severe and needs intubation.

E: Exposure
We must do complete exposure, in order to do 2ry survey(see below) but be careful in exposure not to put the pt in hypothermia.
(in this case, hypothermia is called 2ry trauma-that happens in the time bwn the accident and reaching the hospital)

IMPORTANT: in 1ry survey, always put in your mind the cervical spine injury, until be excluded by x-ray – or lumbar or dorsal spines to lesser extent- so stable the pt during transferring him , by putting a neck collar or something else
يعني بالعربي بقول الدكتور بما معناه بلاش تعمل فزعات وتزم المريض عكتافك وتركض فيه للمستشفى ورقبته بتتحرك..لازم نثبت رقبته اهم اشي بعدين ننقله
And before 2ry survey, when the pt is unstable hemodynamically, you should do ECG. Also we need Pulse oxymetry, chest-pelvic x-rays (to detect any general problems)


SECONDARY SURVEY
In comparison to 1ry survey which takes around 2-5 mins, 2ry survey takes longer time, bcz we examine the pt from head to toe
Also we need to take some Hx about the accident and the pt himself, his past medical Hx, allergy….etc. this Hx could be taken from the pt`s family(3rd party) or from the old file.

Definitive care (management)

After 2ry survey. You can do specific x-ray, blood tests .and any thing to reach a definitive management. Then we do reassessment plan (resuscitation phase)

(( sorry,I couldn’t write the end of the lec. The sound was not clear. But nothing was important))

THANX DEAR ((RANA ALAMAT)) FOR YOUR NOTES 

BEST REGARDS TO THE DEAREST "SISTER" ((BASMA))


The End