2 Why is Trauma Care Important? Leading cause of death in those <40 y3rd leading cause of death in all agesSignificant loss of work force productivity
3 Trimodal distribution of death BackgroundTrimodal distribution of death50% die at sceneWhat do they die of?50% survive to hospital but then die30% die during “golden hour”20% die after prolonged hospital course
4 In ER Patients in their Golden Hour must: Be recognized quickly Have only immediate life threats managedBe transported to an APPROPRIATE facility
5 In ER Survival depends on assessment skills Good assessment results fromAn organized approachClearly defined prioritiesUnderstanding available resources
14 Primary survey A air way + c-spine control Adjunct B breathing + ventilation NG -Foley-Oxygen saturationC correlation + hemorrhage control -FASTD disability + neuro exam DPLE exposure + prevent hypothermia
15 Airway Maintenance with Cervical Spine Protection Signs of airway obstructionInspection for foreign bodiesChin lift or jaw thrustGCS of 8 or less definitive airway managementPrevent excessive movement of the cervical spineInline immobilization techniques
16 Breathing and Ventilation Assess chest wall excursionAuscultationVisual inspection and palpitation
17 B : Breathing and Ventilation Objective signLook : Symmetrical expansionParadoxical movementLocation and depth of the woundListen : Breath soundPulse oximeter :Measure oxygen saturation.
18 B : Breathing and Ventilation Objective signPulse oximetryPa O2 level O2 Hbg Saturation levels90 mm Hg %60 mm Hg %30 mm Hg %27 mm Hg %
19 Circulation with Hemorrhage Control 1. blood volume and cardiac outputLevel of consciousness : impaired cerebral perfusionSkin color : gray skin of face, white skin of extremitiesAccessible central pulse (Radial = 80 mmHg., femoral=70 mmHg., carotid=60 mmHg)Absent central pulses : immediate resuscitation
20 Circulation with Hemorrhage Control 2. bleedingExternal hemorrhage is identified and controlled in the primary surveyDirect manual pressurePneumatic splinting devicesTourniquetshemostat
24 สิ่งที่ต้องพิจารณาว่าต้องทำหรือไม่ ET tube or not C spine protectionICD or ET-tube ICD single or bothOxygen saturation3 sides coverageNG tube or OG tube foley catheterHemorrhage controlFAST DPLUnseen wonud
30 พื้นที่คัดกรองผู้ป่วย (Screening area)Un corrected ER triageUncontrolled Management systemMedical personnels บุคลากรVisitors and press ญาติCrowed of people ไทยมุง
31 ห้องช่วยชีวิตฉุกเฉิน (Resuscitation area)Pitfall in primary survey and c-spine controlDelay or inadequate airway controlDelay or undetection of c-spine injuriesDelay or undetected chest injuriesInappropiate fluid resuscitationUndetected wound of back or perineal wounds
32 If the patient looks sick, he’s sick!!! A blood pressure or an exact respiratory or pulse rate is NOT necessary to tell that your patient is critical !!!!!If the patient looks sick, he’s sick!!!
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