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Mr G AGED 25 YEARS OLD WAS ADMITTED TO THE A&E UNIT FOR POLYTRAUMA FOLLOWING A MVA. EXPLAIN THE ASSESSMENT OF THE TRAUMA PATIENT.

My immediate assessment to the accident and emergency unit for polytrauma are as follow:
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Danger, wear gloves,gaun and mask when handling patient to reduce risk of infection. Assess Responsiveness: Call Mr G name and tap on his shoulder. If no response, call for help and ask bring emergency trolley and defibrillator. Position Mr G place in head /neck control supine position.

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Asses for:  A-AIRWAY  Asses for obstruction ,facial #,tracheal injuries, deviated tracheal etc  Apply cervical collar to immobilize neck and prevent further injury  Open airway by doing jaw thrust maneuver  Open mouth, remove the obstruction or secretion
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Do suction to remove any obstruction eg;secretion,blood or any foreign body Insert orophryngeal or nasopharyngeal airway to maintain patency of airway.

B-BREATHING  Check for spontaneous breathing for 10 sec by look listen and feel.Check for: ` -rate -depth -Use of accessory muscle at neck and abdomen to breath -ASymmetrical breathing,flail chest -Sign of resp.distresswheezing,crowing,gurgling
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-If patient breathing, provide 02 therapy via venturi mask 6l/min,60% o2 concentration.
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If patient not breathing-manually ventilate patient with MRB with 15L/min ,100% oxygen concentration with 10-12bpm

Prepare for intubation and mechanical ventilation. ` Look for sign tracheal deviated  Unequel lung expension can cause pneumothorax.  If present, prepare needle decompression, follow by chest tube insertion
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C-CIRCULATION ` Check the carotid pulse for not> 10 sec ` If carotid pulse present,check for rate and volume of pulse bradycardia,tachycardia,indacated hypovolumic shock. ` Check for blood pressure-maintain SBP >100mmHg , MAP>70mmHg  If pulse not present; -Start chest compression 30:2(5 cycle)
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Set 2 big intravenous line using 16-18FG branula If blood pressure low start fluid resuscitation eg; Crystaloid-n/saline,hartman(1-2pint )over 15min Colloid-gelafundin,voluven(1-2pint) over 15min

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Check color and capillary refill-<3 second To detect any decreased blood flow to the extrimity. Administer blood component after GXM eg whole blood or FFP Check pulse at distal part of the extrimity if patient having # to check for circulation. Check for any bleeding and stop the bleeding by applying compression dressing

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D-DISABILITY Assess for -alert -respond to any verbal or pain stimuli -unresponsiveness Assess level of consciousness by performing GCS If GCS < 8-intubate patient Check pupils reaction, size and equal, if non reactive, increase size or unequal-sign of increase ICP

Check for upper and lower extremities weakness because any lesion in brain shows contralateral effect on limb -look for bruises, dislocation,swelling or abnormal position of the leg. check for any protusion and check pulse, colour,warmth at each extremities.

E-EXPOSURE From Head To Toe ` Check any other injury by doing head to toe examination to detect any injury like deformity, laceration,abnormal movement of the body If limb injury present immobilize: Use RICE technique ` R-Rest the patient ` I-Immobilize ` C-Compression ` E-Elevation.
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Document all assessment done at patient and report for further intervention

THANK YOU