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URGENT.
COMPRISES APPROXIMATELY ABOUT 10-15 % OF ALL PATIENTS.
NON-URGENT.
APPROXIMATELY 80 % OF ALL INJURIES.
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1. Preparation
2. Triage
3. Primary Survey (ABCDEs)
4. Resuscitation
5. Adjuncts to primary survey & resuscitation
6. Secondary Survey (head to toe evaluation & history)
7. Adjuncts to secondary survey
8. Continued post-resuscitation monitoring & re-evaluation
9. Definite care.
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1. PREPARATION
A Pre-hospital phase
Receiving hospital is notified first.
Send to the closest, appropriate facility.
B In Hospital Phase
Advanced planning for the trauma pt arrival.
Method to summon extra medical assistance
Transfer agreement with verified trauma center established.
Protect from communicable disease.
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2. TRIAGE
A Multiple Casualties
no of severity & pt do not exceed the ability of
the facility.
B Mass Casualties
no & severity of pt EXCEED the capability of
the facility & staff.
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3. PRIMARY SURVEY
A : Airway with cervical spine protect.
B : Breathing
C : Circulation --control external bleeding.
D : Disability or neurological status
E : Exposure (undress) & Environment (temp control)
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PRIMARY SURVEY
Priorities for the care of Adult , Pediatrics
& Pregnancy women are all the same.
During the primary survey life threatening
conditions are identified and management is
instituted SIMULTANEOUSLY.
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4. RESUSCITATION
A. Airway
*definite airway if there is any doubt about the pts ability to
maintain airway integrity.
B. Breathing /Ventilation/Oxygenation
*every injured pt should received supplement oxygen
C. Circulation
*control bleeding by direct pressure or operative intervention
* minimum of two large caliber IV should be established
*pregnancy test for all female of child bearing age.
* Lactated Ringer is preferred & better if warm.
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C. Monitoring
1. Ventilatory rate & ABG
2. Pulse oximetry
does not measure ventilation or partial O2 pressure
3. Blood pressure
poor measure of actual tissue perfusion.
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6 SECONDARY SURVEY
Does not begin until the primary survey (ABCDEs)
is completed, resuscitative effort are well established
& the pt is demonstrating normalization of vital sign.
* Head to Toe evaluation & reassessment of all vital
signs.
* A complete neurological exam is performed including
a GCS score.
* Special procedure is order.
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History
A : Allergies.
M : Medication currently used.
P : Past illness/ Pregnancy.
L : Last Meal
E : Events/Environment related to the injury.
*blunt trauma/penetrating trauma/injuries due
to cold & burn/hazardous environment?
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PHYSICAL EXAMINATION
1. Head
Visual acuity
Pupillary size
Hemorrhage of conjunctiva and fundi
Penetrating injury
Contact lenses(remove before edema occurs)
Dislocation of lens
Ocular movement
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2. Maxillofacial Injury
no NG tube, definite airway?
3. Cervical Spine & Neck
*Pt with maxillofacial or head trauma should be presumed
to have and unstable cervical spine.
4. Chest
*elderly pt are not tolerant of even relatively minor
chest injury.
*Children often sustain significant injury to the
intrathoracic structure without evidence of thoracic
skeletal trauma.
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5. Abdomen
*excessive manipulation of the pelvic should be avoided.
6. Perineum/rectum/vagina
7. Musculoskeletal
8. Neurologic
* Protection of spinal cord is required at all times until a
spine injury excluded, especially when the pt is transfer.
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8. RE-EVALUATION
Adult urine output 0.5ml/kg/hr
Pediatric urine output 1mg/kg/hr
*Pain relief -- IM should be avoid.
9. DEFINITE CARE
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Hemorrhage Classification :
Class I Hemorrhage :
up to 15% loss
Class II Hemorrhage :
15-30% loss
30-40% loss
Class IV Hemorrhage :
>40% loss
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3 for 1 Rule
a rough guideline for the total amount of
crystalloid volume acutely is to replace each
ML of blood loss with 3 ML of crystalloid
fluid, thus allowing for restitution of plasma
volume lost into the interstitial &
intracellular space
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Intraosseous Puncture/Infusion
Children less than 6 y/o for IV access is
impossible due to circulatory collapse or
for whom percutaneous peripheral venous
cannulation had failed on two attempt.
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: GCS 14-15
: GCS 3-8
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Thoracic Trauma
8 lethal Injury
1. Simple pneumothorax
2. Hemothorax
3. Pulmonary contusion
4. Tracheo-bronchial tree injury
5. Blunt cardiac injury
6. Traumatic aortic disruption
7. Traumatic diaphragmatic injury
8. Mediastinal traversing wounds.
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Fluid Therapy in
2nd or 3rd Degree Burn
Total amount of first 24 hours:
4 ml of Ringer lactate x BW(kg) x BSA
* give 1/2 in first 8 hrs
* 1/2 in remaining 16 hrs
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2.
Abdominal hemorrhage
3.
Pelvic Hemorrhage
4.
Extremity Hemorrhage
5.
Intra-cranial Injury
6.
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