Trauma is a consequence of harmful behavior that is planned or unplanned. Injury prevention starts with addressing these behaviors.
Goals of trauma patient management Identify and treat threats to life, then limb, and then eyesight. Prevent exacerbation of existing injuries or occurrence of additional injuries. Return patient to a level of function as close to pre-injury as possible.
Outcomes for trauma patients are improved with a systematic, multispecialty, and interdisciplinary approach to pre-hospital, hospital, and rehabilitative care. Principles of trauma patient management Treat the greatest threat to life first.
Primary Survey ATLS Video
Definitive diagnosis is not immediately important. Do no further harm. Assess, intervene, reassess Did the intervention work?
Recognize trouble. Do not delay indicated inter-facility transfer for diagnostic tests. Cardiac tamponade Consider with penetrating mechanism in cardiac cylinder jugular notch to costal margins, circumferentially and hypotension.
Assess for signs of life pulse, blood pressure, cardiac electrical activity, cardiac wall motion on FAST.
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If none, resuscitative thoracotomy not indicated Blunt torso trauma: Patients arriving in cardiac arrest, to include pulseless with cardiac electrical activity, are not candidates for resuscitative thoracotomy.
Hold penis at oblique angle and shoot film.
If extravasation is seen, consider urology consultation for suprapubic cystostomy. If no extravasation, perform cystography. Cystogram may be performed by CT to define bladder injury Insert bladder catheter.
Obtain AP and oblique films with bladder distended to identify intraperitoneal injury. Obtain post-drainage films to identify extraperitoneal bladder rupture.
Assess pulses before and after reduction and splinting. As contaminated or dirty wound, needs treatment with intravenous antibiotics Operative intervention within 6 hours improves outcome.
Continuous monitoring of vital signs and organ perfusion Urinary output ABG pH, lactate, base deficit Pulse oximetry End-tidal carbon dioxide Mentation Skin color, temperature, and capillary refill Assess for adequate analgesia and comfort.
Short-acting narcotics administered IV Benzodiazepines for non-hypoxic anxiety Collect all clinical and radiological data to catalog all injuries. Failure to obtain airway Perseverance on unobtainable orotracheal intubation without movement to surgical airway Failure to diagnose and treat tension pneumothorax with needle decompression Failure to stop the bleeding both external and internal Missed intraperitoneal source of bleeding most commonly the spleen Use of hypotonic resuscitative fluids in traumatic brain injury Failure to maintain normothermia Failure to reassess clinical status of patient Obtaining CT scans in unstable patients Missed extremity fractures most commonly hands and feet Failure to perform tertiary exam after stabilization Inadequate transfer policies in place.
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