PTC Primary Trauma Care Course Slides PDF

PTC Primary Trauma Care Foundation Primary Trauma Care 1 PTC  What is PTC? Primary Trauma Care is a 2 day course training health professionals in acute management of the severely inj...

PTC Primary Trauma Care Foundation Primary Trauma Care 1 PTC  What is PTC? Primary Trauma Care is a 2 day course training health professionals in acute management of the severely injured patient. 2 PTC  PTC Mission Statement A system of training for front-line staff in trauma management Aimed at preventing death and disability in seriously injured patients Using available resources To train clinicians to teach PTC principles in their hospitals 3 PTC  PTC 2 day course At the end you will understand and apply a system for assessing and treating trauma patients have the knowledge, skills and attitudes of the PTC principles apply these PTC principles to where you work 4 PTC  PTC emphasises basic trauma care with the available resources When do trauma patients die? What are the common disabilities? What resources are available? 5 PTC  When do trauma patients die? Seconds - minutes (50% deaths) Brain and spinal cord, heart, great vessels 1-2 hours (35% deaths) Head injury, chest, abdomen, fractures causing large blood loss Days to weeks (15% deaths) Sepsis, organ failure 6 PTC  PTC System Prevention Triage Primary survey Secondary survey Stabilisation Transfer Definitive care 7 PTC  PTC System Triage Sorting patients according to priority Priority depends on experience resources severity of injury 8 PTC  PTC System Primary Survey (ABCDE) rapid examination life-threatening injuries treat as you find Secondary Survey history detailed head to toe examination all injuries special Investigations if available 9 PTC  PTC System Stabilisation includes re-assessment optimisation documentation communication when stable Transfer for definitive care 10 PTC  PTC System ? 11 PTC  PTC System Summary PTC offers a systematic approach rapid assessment and treatment of the injured patient adaptability to all healthcare environments 12 PTC  Primary Survey At the end you will understand the elements of the Primary Survey know when to perform the Primary Survey 13 PTC  Primary Survey Systematic examination to detect life threatening injuries Rapid - 5 minutes Treat as you find Repeat if unstable Universal precautions 14 PTC  Primary Survey Airway + Cervical spine control Breathing Circulation Disability Exposure 15 PTC  A Airway and Cervical spine 16 PTC  Airway Assessment Can the patient talk? Look, feel, listen colour, conscious state accessory muscle use sounds 17 PTC  Airway Beware Airway obstruction Breathing difficulties with chest injuries Cervical spine injury 18 PTC  Airway Management Clear mouth Basic airway Advanced airway Cervical spine protection 19 PTC  B Breathing 20 PTC  Breathing Assessment Is the breathing normal? Are there chest injuries? Look, feel and listen 21 PTC  Breathing Assessment Air / Chest movement Respiratory rate Tracheal deviation Accessory muscle use Percussion / Auscultation 22 PTC  Breathing Beware Life threatening injuries Airway injury Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Lung contusion 23 PTC  Breathing Management Give oxygen Assist ventilation Decompress pneumothorax Drain haemothorax 24 PTC  C Circulation 25 PTC  Circulation Assessment Is the patient in shock? Is there bleeding? Look, feel and listen 26 PTC  Circulation Assessment External bleeding Signs of shock fast pulse poor capillary return low blood pressure 27 PTC  Circulation Beware Life threatening haemorrhage may be hidden chest abdomen pelvis long bone external before arrival 28 PTC  Circulation Management Stop bleeding 2 large bore intravenous cannulae Take blood for crossmatch and base line investigations Give i/v fluid Monitor urinary output. 29 PTC  D Disability 30 PTC  Disability AVPU Is the patient Awake? Is the patient responding to: Voice? Pain? Is the patient Unresponsive? Pupils? 31 PTC  E Exposure (& Temperature Control) 32 PTC  Exposure Are there any hidden injuries under clothing? Keep patient warm 33 PTC  Primary Survey Monitoring Investigations X rays Procedures Pain relief – preferably i/v 34 PTC  Reassessment of ABCDE If patient is, or becomes, unstable 35 PTC  Primary Survey ? 36 PTC  Primary Survey Summary Systematic examination Rapid – 5 minutes Treat as you find Repeat if unstable 37 PTC  Airway and Breathing At the end you will understand the structured approach to airway and breathing be able to recognise and manage airway and breathing problems 38 PTC  Scenario A 25-year-old man falls off the back of a truck and hits his head. On arrival in your hospital, he is unconscious and his breathing is noisy. 39 PTC  Scenario Questions How would you assess his airway quickly? What are the signs of airway obstruction? How would you open his airway? How would you immobilise his C-spine? 40 PTC  Airway Quick Assessment Immobilise Cervical Spine Can patient talk? No Yes Airway not OK Airway OK Open airway Give oxygen Give oxygen Then B 41 then B PTC  Cervical Spine Assume C-spine injury for all severely injured patients Excessive C-spine movement may cause paralysis 42 PTC  Cervical Spine Basic Techniques Manual immobilisation (with hands) C-spine collar Sandbags Tape 43 PTC  Airway Assessment Conscious state Colour Look Chest movement Respiratory distress Foreign bodies Listen Noisy breathing Tenderness Feel Crepitus 44 PTC  Airway Assessment Signs Of Obstruction Noisy breathing snoring, gurgling, stridor Agitation (hypoxia) Use of accessory muscles Paradoxical chest movement Cyanosis 45 PTC  Airway Management Basic Techniques Chin lift Jaw thrust 46 PTC  Airway Management Adjuncts Suction Oropharyngeal airway Nasopharyngeal airway Bag valve mask (BVM) 47 PTC  Airway Management Advanced Techniques Supraglottic airway eg LMA Tracheal intubation Surgical airway 48 PTC  Tracheal Intubation Intubate if: unable to maintain the airway and breathing using basic techniques i Consider intubation if: i risk of aspiration i control CO2 (eg head injury) Patients die from lack of oxygen, not lack of a tube 49 PTC  Surgical Airway Consider if: Unable to intubate Unable to ventilate 50 PTC  Breathing (Ventilation) 51 PTC  Breathing Look Cyanosis Respiratory rate Accessory muscle use Penetrating injury Flail chest Sucking chest wound 52 PTC  Breathing Feel Tracheal shift Rib fractures: tenderness/crepitus Chest wall movement Subcutaneous emphysema Percussion 53 PTC  Breathing Listen Breath sounds Heart sounds Bowel sounds 54 PTC  Breathing Management Give high flow oxygen Assist ventilation if necessary Treat pneumothorax or haemothorax 55 PTC  Breathing Beware Airway injury Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Lung contusion 56 PTC  Tension Pneumothorax 57 PTC  Tension Pneumothorax Signs Look cyanosis, fast breathing rate Feel tracheal deviation, overexpansion increased resonance on percussion ¯ BP Listen ¯ breath sounds 58 PTC  Tension Pneumothorax Management Immediate decompression Large bore needle Second intercostal space Mid clavicular line Formal chest drain must follow 59 PTC  Tension Pneumothorax Should be a clinical diagnosis Treat before X-ray 60 PTC  Airway and Breathing ? 61 PTC  Airway and Breathing Summary Open the airway Give oxygen Assist ventilation as required Consider intubation Never forget cervical spine 62 PTC  Circulation At the end you will understand the structured approach to circulation problems be able to recognise and treat shock 63 PTC  Scenario A 19-year-old woman is hit by a car. When she arrives at your hospital, she is complaining of lower abdominal and right thigh pain. She is pale and sweaty. 64 PTC  Scenario Questions What would you do first ? How would you assess her circulation? What is shock ? Where are the sites of “hidden” bleeding ? How do you treat shock ? 65 PTC  Circulation Assessment Peripheral colour Capillary refill Heart rate Peripheral temperature Blood pressure Urine output 66 PTC  Types of Bleeding Compressible / external usually peripheral Non-compressible e.g. intra-abdominal surgery required 67 PTC  Shock Inadequate organ perfusion and tissue oxygenation Most often due to blood loss in trauma 68 PTC  Circulation Types of shock i Haemorrhagic shock i Non haemorrhagic shock 69 PTC  Shock Clinical Signs Skin - cold, pale, sweaty, cyanosed Respiratory rate Capillary refill time > 2 seconds Pulse rate and blood pressure Urine output < 0.5 ml/kg/hr 70 PTC  Shock Clinical Signs Altered mental state: anxiety to coma Pulse present? radial systolic > 80 mmHg femoral systolic > 70 mmHg carotid systolic > 60 mmHg Tachycardia Pulse pressure narrowed 71 PTC  Shock Hidden haemorrhage Pleural Cavity Abdominal Cavity Pelvic Fractures Femoral Shaft External “blood on the floor and four more” 72 PTC  Shock Sites & approximate blood loss Pelvic # 3 litres Closed Femoral # 1.5-2 litres Closed Tibial # 500 ml Haemothorax 2 litres Hand sized wound 500 ml Fist sized clot 500 ml Rib # (each) 150 ml 73 PTC  Clinical Signs in Shock Blood Heart Blood Capillary Resp Mental Loss rate Pressure Return Rate State 1500- >120 Decreased Prolonged 30-40 Anxious 2000 Confused 74 PTC  Circulation Types of shock i Haemorrhagic i Non-haemorrhagic i cardiogenic and obstructive i neurogenic i septic i anaphylactic 75 PTC  Cardiogenic and Obstructive Shock Myocardial contusion Pericardial tamponade Tension pneumothorax Penetrating wound of heart Myocardial infarction 76 PTC  Neurogenic shock May occur in spinal cord injury Vasodilatation, hypotension and may be slow heart rate Never assume hypotension only from cord injury Look for other injuries 77 PTC  Circulation Management A + B, give oxygen Stop obvious bleeding Two large i/v cannula (14-16 gauge) take blood for cross-match fluid replacement Consider urgent surgical referral 78 PTC  Circulation Stop bleeding Chest drain tube and re-expand lung Abdomen laparotomy if hypotensive after fluids Pelvis: pelvic sling Limbs reduce and splint long bone fracture pressure dressing 79 PTC  Circulation Fluid replacement - How much? 1-2L 0.9% Saline or Ringer’s Reassess 1-2L 0.9% Saline or Ringer’s Reassess Consider blood Consider surgery Aim for systolic BP>90 + HR