PHTH1110 001 Trauma Management - Wright.pdf

Principles of TRAUMA management with a focus on fractures Dr Dean Everett WRIGHT 2022 TRAUMA/ IMPORTANCE LEADING CAUSE DEATH YOUNG Approach Prehospital Transport care by emergency services personnel to hospital Primary survey (ATLS) Transfer to specialized trauma center (if required) Secondary Terti...

Principles of TRAUMA management with a focus on fractures Dr Dean Everett WRIGHT 2022 TRAUMA/ IMPORTANCE LEADING CAUSE DEATH YOUNG Approach Prehospital Transport care by emergency services personnel to hospital Primary survey (ATLS) Transfer to specialized trauma center (if required) Secondary Tertiary survey survey PRE-HOSPITAL MANAGEMENT PRE-HOSPITAL BASIC LIFE SUPPORT ABCDE assessment SAFE TRANSFER SPLINTS ++ A AIRWAY with Cervical Spine Immobilisation B Oxygen delivery/ ± intubation C STOP BLEEDING/ EXTERNAL PRESSURE/ SPLINT INTRAVENOUS ACCESS/ CRYSTALLOIDS NO! TRANSPORT ORGANIZE AT HOSPITAL TEAM VS INDIVIDUAL PRIMARY SURVEY SECONDARY SURVEY IMMEDIATE MANAGEMENT OF MUSCULOSKELETAL INJURY TERTIARY SURVEY PRIMARY SURVEY ABCDE ATLS 1° SURVEY rapidly identify manage impending or actual life threats ADCDE AIRWAY WITH CERVICAL SPINE IMMOBILIZATION BREATHING CIRCULATION DISABILITY EXPOSURE / ENVIRONMENT CONTROL Lethal Six airway obstruction tension pneumothorax cardiac tamponade open pneumothorax massive hemothorax flail chest) DAMAGE CONTROL DAMAGE CONTROL RESUSCITATION SURGERY ORTHOPAEDICS DAMAGE CONTROL ORTHOPAEDICS SECONDARY HISTORY ATLS AMPLE HISTORY/ 2° SURVEY head-to-toe evaluation complete history and physical examination reassessment of all vital signs IMAGING indicated by examination Tertiary Survey post-operative repeat of the primary and secondary survey, usually performed in the ICU/ ward after all the dust has settled. COMPLETE EXAMINATION DEFINITIVE FRACTURE MANAGEMENT FRACTURE FIRST AID Stop bleeding. Immobilize ice pressure/ tourniquet the injured area. … SPLINT packs to limit swelling and help relieve pain. Treat for shock. tourniquet a device that is used to apply pressure to a limb or extremity in order to limit – but not stop – the flow of blood. BEWARE OF TOURNIQUET USE Principles Anatomic reduction- diaphysis, anatomic alignment ensuring that length, angulation, and rotation are corrected as required intra-articular Stable fractures demand anatomic reduction. fixation, absolute or relative, to fulfill biomechanical demands. surgery Fail to achieve adequate reduction Fail to maintain adequate reduction # DESCRIPTION MECH of Injury/ TRAUMATIC / PATHOLOGICAL / STRESS SITE/ SITE/ JOINT/ intra-articular/ dislocation/ DEFORMITY/ SOFT TISSUE INJURY BONE / Location / AVULSION Translation x 3d/ Angulation x 3d/ Rotation RESTORE FUNCTION PREVENT BONE and SOFT TISSUE COMPLICATIONS FUNCTIONAL HEALING EARLY REHAB HOW FRACTURES HEAL ENDOCHONDRAL THREE PHASES RAPID PROCESS REHAB SLOW Factors affecting FRACTURE HEALING GENERAL VS LOCAL # HEALING/ TISSUE RESPONSE BONE ENDS/ opposition vs compression vs gap MOVEMENT/ Micromotion vs NONE vs Macromotion Special Bones/ scaphoid/ talus/ femoral head/ humeral head/ in a joint OPEN/ INFECTION/ TUMOUR # HEALING HIGH vs LOW ENERGY The PATIENT The METHOD OF TREATMENT FRACTURES HEAL/ SURGERY RIGID fixation = COMPRESSION PRIMARY SLOW FAST REDUCTION/ BONE HEALING PROCESS REHAB FRACTURES HEAL/ SURGERY NAILING / EXTERNAL FIXATION CALLUS RAPID PROCESS RAPID REHAB