Early management of trauma patient in the hospital

Logeshini Palaniappan Group D1 Guided by Professor Dinker Pai

Phases of initial assessment

Primary survey Secondary survey Definitive care

Triage categories
Red ( critical) Yellow(semi critical) Green(non critical) Black

Red
Major trauma Life threatening conditions Shock states Airway compromise Severe respiratory distress Seizuring patient

Coma Head injury Severe crush injuries to limbs Burn to more than 25% BSA Gun-shot wound

Yellow
Altered conscious level Head injury Fractures Dislocation of major joints Spine injuries Eye injuries

Limb amputation Burn 15% - 25% of BSA Vascular injuries Uncontrollable major bleeding Severe pain

Green
Close fracture of upper limbs or ankle Dislocations of small joints Burns <15% of BSA Head injury Bruises Simple lacerations or cuts Controllable bleeding

Trauma team
Trauma team leader Primary resuscitator Airway manager Respiratory technician Assistant Trauma nurse Recorder

 Radiology technologist Laboratory technician Case manager

Primary Survey
A B C D E

Cervical spine stabilization first!

Airway
Suctioning/Mechanical removal Chin lift/jaw thrust maneuver Oropharyngeal/Nasopharyngeal airway Endotracheal intubation Surgical airway Tracheostomy

Breathing
Inspection Palpation Percussion Auscultation

Circulation
External haemorrhage-direct pressure Internal haemorrhage-skin colour, pulse, blood pressure 2 large bore IV lines Fluid resuscitation

Disability
Level of consciousness-GCS -Eye opening(4) -Best verbal respone(5) -Best motor response(6) Pupillary response Movement

Exposure

Head to toe examination

Adjuncts to the primary survey

Blood samples- FBC, urea and electrolytes, clotting screen, glucose, blood grouping and cross matching ECG monitoring Pulse oximetry Urinary and gastric catheters Imaging

Radiographs
Lateral cervical spine x-ray Anteroposterior chest x-ray Anteroposterior pelvic x-ray Extremity x-ray

Imaging
FAST CT angiogram CT scan of head CT scan of abdomen CT chest

Secondary Survey
History-A M P L E Head to toe examination

References
The trauma manual-trauma and acute care surgery, Lippincott Williams and Wilkins 3rd edition Bailey and Loves Short Practice of Surgery 25th edition Sabiston 18th edition, volume 1 Emergency Medicine News September 2010 www.medscape.com/emedicine