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Dr. Mohamed El-GindyDr. Mohamed El-Gindy
Professor of SurgeryProfessor of Surgery
MansouraMansouracom.mansfans.www
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)2009 (
85% 15%
% 85% 10
% 5
5 26
6 25
23
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Trauma is the (neglected disease) of
modern society.
It is the number one killer under the
age of 40 years and the 4th cause of
death in all ages.
Significance of traumaSignificance of trauma
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The economic cost of trauma to the
nation is more than $
41 bilion annually.
It causes permanent loss of millions of
productive work years.
Economic cost of traumaEconomic cost of trauma
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The intent of any system of trauma care
must be to fulfil the" 3 Rs"
To get the Right patientTo the Right hospital
At the Right time.
Trauma careTrauma care
" 3 Rs"
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* It can Resuscitate the victim* It can Review (assessment, monitorin
and diagnosis)
* It can Repair (definitive treatment)
" 3 Rs"
The Right Hospital should fulfil
also
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It provides specialised trauma care
(Resuscitate, Review & Repair) .
Educate physicians and paraprofessionals in
trauma care.
Undertake trauma research.
Treat a certain number of severly injured
patient every year.
Level (I) Trauma
Hospital " 3 Rs"
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Trauma CategoriesTrauma Categories
l) Those with injuries that are rapidly fatal (5%)
Death is inevitable
2) Stable patients (80%)
They need little expertise
3)Those with life threatining injuries and required
urgent medical attention (15%).
They need more expertisecom.mansfans.www
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Mechanisms of InjuryMechanisms of Injury
Blunt mechanisms
ForcesCompression forces
Shearing forces
Deceleration forces
SourcesMVCs
Seat belt injury
Steering wheelinjuryFalls
Assaults
Blast
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Mechanisms of InjuryMechanisms of Injury
Penetrating mechanisms
Low velocityKnife
ice pick
Medium velocitygunshot/handgun
shotgun
High velocityhigh power hunting riflemilitary weapon
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Immediate measures at the
scene of accident.
Transportation
Emergency room care
TheThe 3 lines3 lines of managementof management
of theof the injured patient areinjured patient are
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* Handled as if severe injury has occurred.
* Protected from further trauma
* Treated by trained personnel.
the victim should bethe victim should be
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1) Is the victim breathing ?
2) Is there a pulse or heart beats ?
3) Is there gross external bleeding ?
4) Is there any question of spine injury ?
5) Is there any obvious fractures ?
55QQ ?? ??
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a. Airway obstructiona. Airway obstruction
Causes:
* Blood, mucus, vomitus.
* Foreign body (e.g. broken teeth)
* Fallen tongue in comatosed
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1. Simple manipulation of the
mandible
2. Immediate endotracheal intubation
3. Try to remove any foreign body.
Management of AirwayManagement of Airway
obstructionobstruction
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A
B
C
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4. One or two large-bore needles through
the cricothyroid membrane.
5. A lateral and slightly head down position
6. In respiratory arrest, mouth to mouth breathing
Management of AirwayManagement of Airway
obstructionobstruction
(CONT.)(CONT.)
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b. Acute Thoracic Injuryb. Acute Thoracic Injury
Flail Chest
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b. Acute Thoracic Injuryb. Acute Thoracic Injury
Open pneumothorax
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b. Acute Thoracic Injuryb. Acute Thoracic InjuryTension Pneumothorax
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*Absence of heart sounds and pulse*immediate action within 4 minutes.
Mouth to mouth breathing/5 cardiaccompressions.
* Place the victim on a hard surface.*Sharp blow with the Fist to the lower
end of the sternum
*4-5 cm toward the spine once/second.
2. Cardiac Arrest:2. Cardiac Arrest:
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3- HEMORRHAGE
*local pressure and elevation of the limb
*Tourniquet
*kept exposed*loosened / 20 m. for 2 m.
*write ( TK ) on forehead
*on uper arm or thigh
*It may cause vasc. & nerve damage
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ShockShock
*1 ry Shock*1 ry Shock ( pain and fright)( pain and fright)
*Hypovolemic shock*Hypovolemic shock ( loss of blood or plasma)( loss of blood or plasma)
*patient must be recumbent*patient must be recumbent
* Analgesics should be* Analgesics should be (I V(I V((
*fluids until blood trans.*fluids until blood trans.
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The lethal triadThe lethal triad
Bleeding coagulopathy
Acidosis hypothermia
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4- Fracture Spine 4- Fracture Spine
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Pelvic FracturesPelvic Fractures
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Patients should be transported in the supine
position.
Station wagon or truck is preferable
Resuscitation of injured patient should be
maintained
II.TransportationII.Transportation
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Is Pre hospital careIs Pre hospital care
significantly improve thesignificantly improve theoutcomeoutcome
** The answer is equivocalThe answer is equivocal bbecause of :ecause of :
1) Delay from receiving definitive1) Delay from receiving definitive
treatment in the hospitaltreatment in the hospital(2) It may have adverse effects and(2) It may have adverse effects and
compromise the patient furthercompromise the patient further ..
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is a new Aproachis a new Aproach
Except forExcept for
* Unavoidable delay due to entrapment.* Unavoidable delay due to entrapment.
* Inaccessible sites.* Inaccessible sites.* In rural locations* In rural locations..
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11((Size & demography of the populationSize & demography of the population 2)2)
Local geographical constraintsLocal geographical constraints
3) Rural or highly urbanized3) Rural or highly urbanized areaarea
The prehospital care directlyaffected by:
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**Fire and police services do the BASIC support .Fire and police services do the BASIC support .
** Emergency paramedics do the advanced skills andEmergency paramedics do the advanced skills and
communication links with the receiving hospital .communication links with the receiving hospital .
** Severely injured patient may bypass theSeverely injured patient may bypass the
nearest facility to the proper trauma centrenearest facility to the proper trauma centre
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Hopping forHopping forcom.mansfans.www
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Hopping forHopping for
1-The Basic Care by the1-The Basic Care by the
police manpolice man
2- Augment the ambulance service2- Augment the ambulance service
3- Paramedic & physician in each3- Paramedic & physician in each
4- Advanced skills by the team inside4- Advanced skills by the team inside
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Transportation to theTransportation to the nearest hospital ??nearest hospital ??
Augment the communication linksAugment the communication links
7- Accident flying squads using Helicopters7- Accident flying squads using Helicopters
in inaccessible sitesin inaccessible sites
Hopping for
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III Emergenc Room CareIII Emergency Room Care
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III Emergency Room CareIII Emergency Room Care
1- General Principles :
1) Patient clothing (cut off).
3) History of :
a. medical diseases.
b. circumstances of the injury .
4) Findings should be "written records
(for medicolegal and follow up
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Do not remove the stab
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Do not remove the stab
except in OR.
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Impalement Injury
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2. Resuscitation
a. I.V catheters b. I.V Fluids
c. (C. V. P.) d. Foleys
catheter
e. Antitetanic, antigasgangrene serum if
III Emergency Room CareIII Emergency Room Care
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III Emergency Room CareIII Emergency Room Care
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4. Radiological Study
* X-ray chest and abdomen in all cases of major injury.
* I.V.P. in abdominal and pelvic injuries with evidence of
urinary
tract injury
* X-ray skull, C.T. scanning of the head in most of head
injuries.
III Emergency Room CareIII Emergency Room Care
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Thermal Trauma
E t i Th l T
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Extensive Thermal Trauma
Special Bed for Extensive Thermal Trauma
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Special Bed for Extensive Thermal Trauma
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Bullet Injury of the
heart and abdomen
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Blunt Abdominal Trauma
Flank ecchymosis from internal bleeding
Blunt Closed Abdominal Trauma
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Blunt Closed Abdominal Trauma
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Certain injuries are so critical thatthatoperative treatment must be undertaken as
soon as the diagnosis is made ( penetrating
wound of the heart , abdominal wounds
involving the aorta and vena cava )
Cerebral injuries take priority in care
only when there is rapidly deepening coma and
evidence of extra dural bleeding .
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Laparotomy for abdominal injury and
craniotomy for cerebral injury can becarried out simultaneously .
Fractures of long bones can be treated on
a semiemergency bases unless
there is associated vascular
injury or open fractures
Hand injury should be treatment as early
If th ti t i t d
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Alcoholic intoxication . Cerebro vascular accident .
Diabetic coma .
Barbiturate Poisoning
Hypovolemic shook .
If the patient is comatosed :
The cause may be :
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