Trauma Management Overview and Techniques

Aug 31, 2024

Trauma Management Lecture

Patient Case Overview

  • Patient: 34-year-old male
  • Incident: Road traffic accident
  • Symptoms: Tense and tender abdomen, right upper quadrant pain

Initial Assessment

  • Concern: Intra-abdominal bleeding
  • Approach: A to E (Airway, Breathing, Circulation, Disability, Exposure)
  • Focus: Circulation (C)

Airway (A)

  • Ensure airway is patent and secure
  • Techniques:
    • Head tilt, chin lift

Breathing (B)

  • Administer oxygen
  • Use pulse oximeter
  • Examine the chest:
    • Inspect accessory muscles
    • Palpate
    • Check for pneumothorax (e.g., tracheal deviation)
  • Management of Tension Pneumothorax:
    • Needle thoracotomy
    • Chest tube insertion in safety triangle
    • Locations:
      • Needle thoracotomy: 2nd intercostal space, midclavicular line
      • Chest drain: 5th intercostal space, midaxillary line

Circulation (C)

  • Rule out sources of bleeding:
    • External bleeding
    • Chest, abdomen, pelvis, lower limbs ("floor and 4 more")
  • Immediate actions:
    • Insert two wide bore cannulas
    • Take blood tests including coagulation, group and screen
    • Start IV fluids
    • Consider massive hemorrhage protocol

Disability (D)

  • Assess consciousness (GCS score)
  • Check blood glucose
  • Assess AVPU (Alert, Voice, Pain, Unresponsive)

Exposure (E)

  • Log roll patient to assess the back
  • Take AMPLE history (Allergies, Medications, Past medical history, Last meal, Events leading to injury)

Imaging and Diagnosis

  • Chest X-ray: Identified pneumothorax
  • CT Scan: Identified liver laceration

Types of Shock

  • Cardiogenic Shock: Heart function
  • Obstructive Shock: Outflow obstruction
  • Hypovolemic Shock: Fluid deficiency
  • Distributive Shock: Vascular tone

Liver Laceration Grading

  • Grading based on Hematoma Size:
    • Grade 1: <10%
    • Grade 2: 10-50%
    • Grade 3: >50%
    • Grade 4: Up to 75%
    • Grade 5: >75%
  • Grading based on Laceration Width:
    • Grade 1: <1 cm
    • Grade 2: 1-3 cm
    • Grade 3: >3 cm
    • Grade 4-5: Vascular or hepatic avulsion

Management of Liver Laceration

  • Conservative:
    • Monitor hemodynamics
    • Blood transfusion if necessary
  • Surgical:
    • Damage control repair
    • Possible liver resection

Imaging Considerations

  • Fast Scan: Quick bedside ultrasound to assess critical areas
  • CT Scan: Detailed examination once patient is stable

Conclusion

  • Quick tone on tension pneumothorax and liver laceration management
  • Importance of using FAST scan to quickly assess trauma.

Thank you for attending the lecture.