trauma care outline

7/31/2019 Trauma Care Outline

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TRAUMA CARE: INITIAL ASSESSMENT AND MANAGEMENTIN THE EMERGENCY DEPARTMENT (2009)

Chapter 1. Mechanism of Injury -

MECHANISM OF INJURY - AN OVERVIEWBLUNT TRAUMAIntroduction1. Road Traffic Accidents (RTAs)2. Pedestrian impact3. Cycle and motorcycle accidents4. Assaults5. FallsPENETRATING INJURIESIntroductionCavitationGunshot woundsStab woundsImpalementsBLAST INJURIESIntroductionPrimary blast injuriesSecondary blast injuriesTertiary blast injuriesINJURY SCORING SYSTEMSCONCLUSIONREFERENCESTABLESTable 1.1. Pre-hospital information requiredFIGURESFig. 1.1. Vehicle rollover RTA.Fig. 1.2. Restraint injury.

Fig. 1.3. Three phases of injury


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Chapter 2. Initial Assessment and Resuscitation of the Trauma Patient -

TRAUMA CARE IN THE EDThe trauma teamHorizontal vs. vertical assessment of the trauma patientPRIMARY SURVEY: INITIAL ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlHypovolaemic shockAssessment of circulationDisability and dysfunctionExposure and environmental controlAnalgesiaTetanusDiagnostic imagingSECONDARY SURVEYDocumentationPropertyCare of relatives and friendsTransfer to definitive care

TABLESTable 2.1. Systematic airway assessmentTable 2.2. Altered vital signs in response to haemorrhageTable 2.3. Immunisation recommendations for clean and tetanus-prone woundsFIGURESFig. 2.1. Jaw thrust.Fig. 2.2. Sizing an oropharyngeal airwayFig. 2.3. Needle cricothyroidotomy.Fig. 2.4. Four-person log roll


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Chapter 3. Head Injuries -

ANATOMYScalpBoneMeningesBrainPHYSIOLOGYPrimary and secondary brain injuriesSPECIFIC BRAIN INJURIESConcussionContusionTraumatic axonal injuryExtradural haematomaSubdural haematomaIntracerebral haematomaPenetrating injuries to the brainPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental controlCT SCANNING FOR THE HEAD INJURED PATIENTTRANSFER PROTOCOLS

TABLESTable 3.1. The Glasgow Coma ScaleFIGURESFig. 3.1. Regions of the head and brainFig. 3.2. Le Fort fracturesFig. 3.3. Cross section of the head and brain including the meningesFig. 3.4. Extradural haematomaFig. 3.5. Subdural haematoma


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Chapter 4. Thoracic Trauma -ANATOMY OF THE CHESTThe lungsThe heartMECHANISM OF THORACIC INJURYBlunt traumaPenetrating traumaSPECIFIC THORACIC INJURIESThe lethal sixThe hidden sixPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCIRCULATION AND HAEMORRHAGE CONTROLIntravenous fluids for the patient with a thoracic injuryDisability and dysfunctionExposure and environment controlINDICATIONS FOR A THORACOTOMY IN THE EDTABLESTable 4.1. Major thoracic injuriesFIGURESFig. 4.1. Structures within the thoraxFig. 4.2. Right pneumothoraxFig. 4.3. Chest drain insertion.


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Chapter 5. Spinal Injuries -

ANATOMY OF THE SPINE AND CORDThe spinal columnThe spinal cordMECHANISM OF SPINAL CORD INJURYBlunt traumaPenetrating traumaPRIMARY AND SECONDARY SCIPrimary SCISecondary SCI

SPINAL SHOCK AND NEUROGENIC SHOCKSpinal shockNeurogenic shockPRIMARY SURVEY ASSESSMENT AND RESUSCITATION

Airway and cervical spineBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental controlClearing the cervical spineDIAGNOSTIC IMAGING FOR THE SPINAL INJURED PATIENTSCIWORADEFINITIVE CARE FOR THE SPINAL INJURED PATIENT

TABLESTable 5.1. Spinal column movements caused by blunt forceTable 5.2. Comparison of hypovolaemic shock with neurogenic shockFIGURESFig. 5.1. Level of spinal injury and extent of paralysis.Fig. 5.2. Zones of penetrating neck injury


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Chapter 6. Abdominal Injuries -

ABDOMINAL ANATOMYMECHANISMS OF ABDOMINAL TRAUMABlunt abdominal traumaPenetrating abdominal traumaSPECIFIC ABDOMINAL INJURIESThe liverThe spleenThe diaphragmThe kidneysEviscerationPenetrating objectsPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental control

FIGURESFig. 6.1. The four quadrants of the abdomenFig. 6.2. Penetrating abdominal injuryFig. 6.3. FAST regions


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Chapter 7. Pelvic Injuries

ANATOMY OF THE PELVISMECHANISM OF PELVIC INJURYCLASSIFICATION OF PELVIC FRACTURESAnterior-posterior (AP) compression fractures (Figure 7.2)Lateral compression injury (Figure 7.3)Vertical shear injury (Figure 7.4)Complex pattern injuryPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental controlMANAGEMENT OF PELVIC INJURIESDiagnostic imagingHaemorrhage control

TABLESTable 7.1. Force relating to pelvic injury classificationFIGURESFig. 7.1. The pelvisFig. 7.2. Anterior-posterior pelvic injury.Fig. 7.3. Lateral compression pelvic injury.Fig. 7.4. Vertical shear pelvic injury.Fig. 7.5. Decision making algorithm for the management of pelvic fractures.


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Chapter 8. Extremity Trauma -

LIFE- AND LIMB-THREATENING EXTREMITY TRAUMABony injuriesTraumatic amputationWoundsCrush injuriesCompartment syndromeVascular injuryNerve injuryPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental control

TABLESTable 8.1. Life- and limb-threatening extremity traumaTable 8.2. Signs of arterial or vascular injuryFIGURESFig. 8.1. Traumatic amputation of the left armFig. 8.2. Amputated armFig. 8.3. Degloving injury of the foot


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Chapter 9. Burns -

MECHANISM OF BURN INJURYChemical burnsElectrical burnsThe burn victim with associated injuriesPRIMARY SURVEY ASSESSMENT AND RESUSCITATIONAirway with cervical spine controlBreathing and ventilationCirculation and haemorrhage controlDisability and dysfunctionExposure and environmental controlREFERRAL AND TRANSFER

TABLESTable 9.1. Important indicators in a history of burn injuryTable 9.2. Burn depthTable 9.3. Transfer considerations for the burn injured patientFIGURESFig. 9.1. Cross section of the skinFig. 9.2. Burn injuryFig. 9.3. The Lund and Browder chart8


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Chapter 10. Paediatric Trauma -

MECHANISMS OF INJURYANATOMICAL AND PHYSIOLOGICAL DIFFERENCES IN CHILDRENAirwayCervical spineBreathingCirculationDisabilityPRIMARY SURVEY, ASSESSMENT AND RESUSCITATIONAirwayCervical spine immobilisationBreathingCirculation and haemorrhage controlDisabilityExposureAnalgesia for injured childrenSECONDARY SURVEYCervical spine clearance and SCIWORAChild protectionPsychological effects of trauma

TABLESTable 10.1. Normal paediatric observation parameters according to ageTable 10.2. Endotracheal tube length and diameter calculationTable 10.3. Appropriate sizes for bag-valve-mask ventilationTable 10.4. Children's Glasgow Coma ScaleFIGURESFig. 10.1. Jaw thrust manoeuvre in a childFig. 10.2. Cervical spine immobilisation in the distressed childFig. 10.3. Intraosseous needle insertionFig. 10.4. Log rolling an Infant


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Chapter 11. Trauma in Older People -

PHYSIOLOGY OF AGEINGPRIMARY SURVEYAirway and cervical spine controlSECONDARY SURVEYAbuse of the older personTABLESTable 11.1. Physiological changes associated with ageingFIGURESFig. 11.1. Kyphosis

Chapter 12. Trauma in Pregnancy -

ANATOMICAL AND PHYSIOLOGICAL CHANGES IN PREGNANCYUterusCardiovascular systemRespiratory systemHaematological changesGastro-intestinalUrinaryMusculoskeletalNeurologicalASSESSMENT AND RESUSCITATION OF THE PREGNANT WOMANPrimary surveySecondary surveySpecific problems for the traumatised pregnant patientEmergency caesarean sectionDOMESTIC VIOLENCE AND THE PREGNANT TRAUMA PATIENTTABLESTable 12.1. Anatomical and physiological changes in pregnancyFIGURESFig. 12.1. Pelvic wedge in situ to displace the uterus.Fig. 12.2. Cervical spine immobilisation for the pregnant patient with a wedge in situ


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Chapter 13. Trauma-related Deaths -

THE CORONERReporting deaths to the coronerCare of propertyCare of the bodyMedical recordsAttending a coroner's inquestTHE POLICE SERVICEConfidentiality and disclosure to a police officerDISCLOSURE TO OTHER AGENCIESORGAN AND TISSUE DONATIONFORENSIC EVIDENCEVisualPhysicalTrace evidenceBiologicalBehaviouralDOCUMENTATIONCARE OF THE RELATIVES

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