Initial management of trauma patients

1
???????????????????????????????(
???????????????? )

• Initial management of trauma patients

????? ??? ???????????????????
??
2
????????????????? ????????????????????????????????
? ..... ?????????????.....
???????????????? Primary survey
??????????????????? pt.????????? ????
Resuscitation ????????????????????? ????????
??? Hx. ???????????????????????? Secondary
survey ??????????????????????? Definitive
care
3
??????????????????????? ( Primary survey
) ?????...???????????????????????????????????????
?????????????????????????????????????????????????
?????????????????? ????????????
??????????????????????????????????????????..?????.
.????????????? pt.???????????????????
???????????????????????????????????????
pt.????????? ???? Dx.????? ???????????????????????
????????????????????? 1.Air-way and
C-spine 2.Breathing 3.Circulation 4.Disab
ility 5.Exposure
4
A Airway ??????????????????? ???????
?????? ???????? ????? ????????????????????
??????? ?????????????????????
??????????? ????????????? ???????????????? ????
snoring ???? gurgling sound ?????? accessory
muscles of respiration ??????????? ???????
???????????? ??????????????? hypoxia
????????? Hypercarbia ???????? ???????????????????
???? ???? nerve ???????????????????
noarseness ????????????????????????
???? C-spine
5
B Breathing ???????????????? ??????????????????
?????? ???????????? (????????????????????????????
?????????) ????? ! tension peumothorax ,
open peumothorax fail chest with
pulmonary contussion ??? massive
hemothorax Dead
6
C Circulation ?????????????????
???????????? bleed ?????? ???????? ??????
pulse ?????????????? ????????????? B.P.??????
radial pulse ..systolic pressure ???? 80
mmHg femoral pulse. systolic pressure
???? 70 mmHg carotid pulse..... systolic
pressure ???? 60 mmHg ??????????????????????
cyanosis ???????????????????????
???????????????????? ???????? ( ??????,??????? )
7
D Disability ?????????????????
?????????????????????????????? ???????????????????
??? AVPU method ??? A alert V vocal
stimuli P pain stimuli U
unresponsive ????????????????????????????????
Glasgow coma score
8
E Exposure ????????????????????? ???????????????
?????????????? ????? hypothermia
RESUSCITATION ????????????????????????????????
pt.????????? ???????????????????????????
pt.??????????? ??????????????????????..CPR
?????????????????????????????? CPR
????????????????????????? A B C
9
A ?????????????????????????????????? C-spine
???????? 2 ??????? Basic life support
position,air way ??????? oral airway or nasal
airway Advance life support
E.T.tube
B ?????????????????????
??????????????????????????????????????????
?????? On oxygen cannular or mask or
E.T.tube
10

• C ????????????????????????..................????
  ?????????????????????????????????
• ?????????
• ??????????????????????????..........??????????????
  ?? ???? 16
• (????????????????? ???????????????????????????????
  ? )
• -?????????????????????????????????????????........
  ???????????????
• -???????????????????? shock ???????????? IV
  ????????? cutdown
• -Lab ???? CBC ,DTX ,Elyte ,BUN ,Cr-
• -?????????????????????????????? crystalloid ????
  RLS , NSS
• -pt.??? shock ??????????????????
  ??????????????????????????????
• -pt.??? shock ??????????? ?????????????
  antibiotic

11
????????????????????????????? ( Secondary
survay ) ?? 2 ??????? ??? 1.????????????? 2.?????
?????????????????????????? ???????????????????
????????????? 2 ???? ??? ?????????????
????????????????? ???????????????? AMPLE
??????????????.......????????????? ???????
???????? (??????????????)
12
AMPLE
A allergies M medication P past illness L
last milk E events
13
?????????????? ??? DCAP BTLS ?????????????????
Head to toe D Deformities C Contussion A
Abrasion P Puncture Penetration B Burn T
Tenderness L Lacerlation S Swelling
14
???????? ( Definitive care )
????????????????????????????????
??????????????????????????????????????????????????
???????????????????????????????????
?????????????? ???????????????????????
??????????????????????? ???????????????
??????????????? ??????????????????????????????????
??????????????? ??????????????????
??????????????????????????????????????????????????
????????????? ?????????????
15
????
??????????????????????????????????????
??????????????????????????????????????????????????
?????? ???????????? ???????? c-spine ????????????
??? ???????? ??????????????????????
????????????????(AVPU)??????????
???????????????????????????????????????(DCAP
BTLS) ???????????????????????????
?????????????????????????????????????????????????
???????????(AMPLE)?????????? ?????????????????????
????????????? ????????????????????????????????????
??????????????????
16
??????