Archive for the ‘ L4-First Aid ’ Category

L4- First Aid of Poly Traumatized Patient

First Aid of Poly Traumatized Patient

Incidence: Egypt 2004

  • 26 000 motor care accident.
  • 23 000 injured patients.
  • 6 000 dead cases.
  • 5 billion EP loses.

-Trauma is the (neglected disease) of modern society.

-It is the number one killer under the age of 40 years and the 4th  cause of death in all ages.

Trauma Categories

-Those with injuries that are rapidly fatal (5%) -Death is inevitable

-Stable patients (80%) -They need little expertise

-Those with life threatening injuries and required urgent medical  attention (15%) – They need more expertise

Assessment:

-Usually assessment & treatment are going concurrently.

-Requires intensive monitoring during transport, in emergency department, in intensive care unit & in OR.

-Rapid clinical assessment may provide some clues to the cause.

-Pulse, Blood Pressure, Respiratory rate & treatment.

-Blood Sample for: Hb, Ht, urea, electrolytes & cardiac enzymes.

-Blood Grouping & cross matching

-Blood culture if sepsis is suspected.

-Urine output documented hourly through a catheter.

-ECG monitoring nCVP: Rt. ventricular Bl.P

-PAWP: Lt. ventricular function

-Blood gases

-Blood lactate

Management: 3 distinct occasions

-Immediate measures at the scene of accident.

-Transportation

-Emergency room care

1) Immediate measures

When first seen

-The victim should be

  • Handled as if severe injury has occurred.
  • Protected from further trauma
  • Treated by trained personnel.

Care for Shock:

-Keep the victim laying down (if possible).

-Elevate legs 10-12 inches… unless you suspect a spinal injury or broken bones.

-Cover the victim to maintain body temperature.

-Provide the victim with plenty of fresh air.

-If victim begins to vomit – place them on their left side.

-Call 123.

5 Q ?

1)Is the victim breathing ?

2)Is there a pulse or heart beats ?

3)Is there gross external or internal bleeding?

4)Is there any question of spine injury ?

5)Is there any obvious fractures ?

CARDIOPULMONARY RESUSCITATION CPR ABC’s

  • AIRWAY – Open the airway with the tilt-chin method.
  • Breath – give two breaths.
  • Check circulation.

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Breathing

a. Airway obstruction.

b. Acute-thoracic injury.

Airway obstruction

-Causes:

  • Blood, mucus, vomitus.
  • Foreign body (e.g. broken teeth)
  • Fallen tongue in comatosed patients.

-Management :

  • A lateral and slightly head down position
  • Try to remove any foreign body
  • Simple   manipulation   of   the   mandible

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  • In respiratory arrest, mouth to mouth breathing (1 breath every 5 seconds – 12 per minute)

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  • One or two large-bore needles through the cricothyroid membrane.
  • Immediate endotracheal intubation.

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  • Immediate Endotracheal intubation

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Cardiac Arrest

-Absence of heart sounds and pulse.

-Immediate action within 4 minutes.

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Management of Cardiac Arrest

  • Place the victim on a hard surface.
  • Sharp blow with the Fist to the lower end of the sternum
  • 4-5 cm toward the spine once/second

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Bleeding:

Apply direct pressure: pressure bandage may be used)

Elevate: (do not further harm)

-Tourniquet:

  • kept exposed
  • loosened / 20 m. for 2 m.
  • write ( TK ) on forehead
  • on upper arm or thigh
  • It may cause vasc. & nerve damage

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Sprains & Strains: I-C-E

I – Ice, apply a cold pack. Do not apply ice directly to skin.

C – Compress, use an elastic or conforming wrap – not too tight.

E – Elevate, above heart level to control internal bleeding.

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Dislocations & Fractures

-Improper Handling of Fractures may cause:

  • Damage of nerves, blood vessels.
  • Puncture of the skin overlying it (compound).
  • Severe pain which increase the shock state.

-Splinting using boards, pillows, blankets or any other materials

-Exceptions of splinting fractures at the scene of accident:  Fire, Explosion, Escaping gas.

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2) Transportation:

Objective is to Provide:

1)Continue resuscitation.

2)Safe and rapid transportation to the most appropriate hospital.

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-Patients should be transported in the supine position.

-Station wagon or truck is preferable.

-Resuscitation of injured patient should be maintained.

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Problems

  1. Unavoidable delay due to entrapment.
  2. Inaccessible sites.
  3. In rural locations.

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3) Emergency Room Care:

The Aim of Treatment is to:

  1. Resuscitate the patient.
  2. Improve tissue perfusion
  3. Deal with the cause.
  4. Prevent & treat complications.

General Principles:

  • Patient clothing (cut off).
  • History of :
  1. Medical diseases.
  2. Circumstances of the injury .
  • Findings should be “written records”

If the patient is comatosed:

  1. Alcoholic intoxication .
  2. Cerebro vascular accident .
  3. Diabetic coma .
  4. Barbiturate Poisoning
  5. Hypovolemic shook .

-Repeat all assessments steps.

-ABC.

-Complete bed rest

-100% Oxygen via air mask.

-Restoration of circulating volume: Crystalloid, Colloid, Blood, Blood products.

-Pain relief; diamorphine or morphine.

-Antibiotics if infection is suspected.

-Inotropes is often indicated.

-Steroids is controversial.

-H2 blockers.

Radiological Study

-X-ray chest and abdomen in all cases of major injury.

-Abdominal US & CT in abdominal and pelvic injuries.

-X-ray skull, C.T. scanning of the head in most of head injuries.

-X-ray of bones if there is evidence of fracture.

Treatment Priority:

-Penetrating wound of the heart.

-Abdominal wounds involving the  aorta and vena cava.

-Cerebral injuries: rapidly deepening coma and evidence of extra dural bleeding.

-Laparotomy

-Craniotomy

-Fractures: semi emergency bases unless there is associated vascular or nerve injury or open fractures

-Hand injury: as early as possible to avoid infection.

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