Beruflich Dokumente
Kultur Dokumente
Faculty of Medicine
Universitas Swadaya
Gunung Jati
Cirebon
Introduction
Scope :
Congenital &
developmental Subdivision :
abnormalities Traumatology
Infection & inflammation Orthopaedi :
Arthritis & rheumatic
disorders 1. Adult Reconstruction
Metabolic & endocrine 2. Oncology
disorders Orthopaedic
Tumours 3. Pediatric Orthopaedic
Sensory disturbance &
muscle weakness 4. Spine
Injury & mechanical 5. Hand & Microsurgery
derangement 6. Sports Injury
7. Ankle and Foot
Introduction
Trauma commonest cause of death in people
from 144 years
Trauma Surgeon
TEAM LEADER
Anesthesia Interventional
Musculoskeletal radiology
Intensivist
traumatologist
Neurosurgeon Hospital Staff-
Vascular/CT surgeon Nursing,
Urology, Speech, Admin.
Legal/Security
Gynecology
Social work
Ministry
Trauma Surgeons and
Fracture Care
Europe - General
Surgeon
Traumatologists
treat all injuries
North America -
Multidisciplinary team
Orthopaedic
Traumatologist- broad
knowledge of treatment of
injuries involving other
organ systems to
coordinate care optimally
with colleagues
Orthopaedic Traumatologist
General resuscitation /
ICU care
Advantages /
disadvantages of early
stabilization of long bone
fractures
Skilled sufficiently to do
a procedure
expeditiously with
minimal risk of
complications
Understands impact of
Polytrauma Patient
Peripheral Pulse
radial
femoral
Systolic Blood
carotid
Pressure
80 mm Hg
capillary refill > 2 70 mm Hg
secs 60 mm Hg
Hypotensive
Hemorrhage
Classification
Resuscitation
Two peripheral large
bore Ivs (16)
Two liters of Ringers
Lactate
If no response then severe
hemorrhage has occurred
immediate blood is
needed
Monitor
Blood pressure
Urinary output
Base deficit
Initial Hematocrit/Hemoglobin
-unreliable
Types of Shock
Hemorrhagic
Cardiogenic-pericardial tamponade
Neurogenic-CHI, spinal cord injury
hypotension without tachycardia
Vasoconstrictive meds not administered
until volume is restored
Septic-late sequela
Blood Transfusion
Blood warmer-
Crossed Matched prevents hypothermia,
1 hour arrhythmias
Blood filters-160 u
Type Specific
10 minutes
macropore
Coagulation status-
Type O Rh neg Platelets monitored
immediately every 10 units
Platelets < 100,000-
replace
Labile factors
(fibrinogen)-replace with
FFP
Management of Shock
Summary
Direct control of bleeding sources
Large bore IV access-Fluid
replacement
Monitor-urine output, CVP, pH,
lactate level
Blood replacement-indicated by
clinical response
Secondary Survey
Head
skull trauma
reevaluate pupillary size and reaction
blood/fluid at tympanic membranes
and nares
facial and ethmoid fractures
Cervical spine
swelling, crepitus, expanding
hematoma
Neurological Exam
Glascow Coma
Score-GCS
Pupil exam-
intracranial
pressure
Motor and Sensory
- all extremities in
alert patient
Secondary Survey
Chest-reevaluate for
crepitus, fractures, flail
segments,open wounds
Abdomen-inspect,
auscultate, palpate
seat belt injury-spinal
or intraabodominal
injury
Pelvis-exam for
tenderness, instability
Secondary Survey
Rectal exam
tone, sensory, prostate injury
if abnormal, do not pass foley-consult
Urology
Extremity exam
palpate for crepitus, swelling, pain,
instability, range of motion
Neurological exam-document all
findings
Head Injury
Meningeal
Brain tissue
Suspect in unconsciousness patient
or lateralizing signs
fixed pupil
Increased Intracranial Pressure
Treatment
Patient positioning
Fluid restriction
Hyperosmotic diuretics-mannitol
Deliberate hypocapnia
controlled hyperventilation
maintain pCO2 at 25-30 mm Hg
Avoidance of stimuli
Thoracic Trauma
Secondary survey-
pulmonary contusion, aortic
disruption, airway disruption,
traumatic diaphragmatic disruption,
myocardial contusion
CXR-aortic disruption
widened mediastinum, fracture of 1st
and 2nd ribs, sternum fracture,loss of
aortic knob, trachea and esophageal
deviation
Aortagram of the aortic arch
Thoracotomy Indications
Failure of resuscitation
Penetrating injury to the
mediastinum
Continued thoracic hemorrhage
Failed pericardiocentesis
Tracheal, bronchial, esophageal
rupture
Abdominal Trauma
Ultrasound
CT scan
Method used for abdominal
evaluation is often institutionally
dependent
Genitourinary Injuries
Seen in 15% of blunt
abdominal injuries
Clinical signs
lower rib fracture, flank
discoloration, lower
abdominal mass, genitalia
discoloration, inability to
void, blood at the meatus,
hematuria
Evaluation
Retrograde urethrogram-
before foley is placed
Hematuria-IVP, cystogram,
excretory urethrogram
Trauma Severity Scores
Physiologic
Trauma Index-
Kirkpatrick and
Youman
Glascow Coma Scale
Anatomic Damage
Abbreviated Injury
Scale (AIS)
Injury Severity Score
(ISS)
Biochemical
Indices
Orthopaedic Surgeon
Bending
Axial Loading
Figure from: Browner et al: Skeletal Trauma 2nd Ed, Saunders, 1998.
Fracture Mechanics
Bending load:
Compression
strength greater
than tensile
strength
Fails in tension