Initial Assessment of Trauma Patients

Leema Rebekkal Rosy

Assistant Nursing Superintendent, Kauvery Hospital, Tennur, Trichy

Epidemiology

Almost 3242 persons die each day around the world. 50 million people are disabled or injured each year. In India 1% of motor vehicles in the world but bears the burden of 6% of global vehicular accidents. Unfortunately, a majority of trauma survivors are either confined to bed or wheel chair for the rest of their lives

The tragedy of India

78% of the victims – men, 20 to 44 years, causing significant impact on productivity. A vehicular accident reported every 3 min and a death every 6 min on Indian roads.

Pitiable Condition of Our Roads

Trimodal distribution of death

Golden Hour

The first hour following a trauma during which aggressive resuscitation can improve the chances of survival and restore the normal functions. Early pre-hospital care, early transport, aggressive resuscitation and interventions in ED, continued care in ICU have a definite and significant role in preventing deaths due to trauma.

Platinum Minutes

The importance of time in trauma is increasing as evident from the evolution of the concept of

‘The Platinum Ten Minutes

Initial Approach to Trauma Care’

Process that consists of;

  • Initial primary assessment
  • Rapid resuscitation
  • A more thorough secondary assessment
  • Followed by diagnostic tests and disposition.

Pre-hospital information and handover

M-I-S-T

  • Mechanism of injury
  • Injuries sustained or suspected
  • Signs- vitals on scene and during transport
  • Treatment initiated

Primary Survey

Identify the life-threatening conditions and manage simultaneously

A: Airway maintenance with cervical spine protection

B: Breathing and ventilation

C: Circulation with hemorrhage control

D: Disability (Neurologic status)

E: Exposure (Undress the patient & prevent hypothermia)

Special Groups

Pediatric

  • Same Priorities and Approach
  • Need for different amounts of fluids and medications
  • Need for equipment of varying sizes

Pregnant Women

  • Same Priorities and approach
  • Anatomic and physiologic changes
  • Potential two patients not one
  • “Treat the Mother to Treat the Fetus”

Elderly

  • Diminished physiologic reserve
  • Co morbidities
  • Heart disease, Diabetes, lung disease
  • Multiple medication use
  • Increased risk of death for any given injury compared to younger patient

Airway Assessment and C-Spine Control

The New A-B-C

A – Airway

B – Be Careful of the Airway

C – Concentrate on the Airway

MILS – Manual In Line Stabilisation

Obstructed airway

Pre-intubation-

  • Supplement oxygen
  • Oropharyngeal suction
  • Jaw thrust
  • Oro-pharyngeal airway

Rapid sequence induction and endo-tracheal intubation

Difficult airway anticipated-

  • Airway injury
  • Head and neck injury
  • Short neck
  • Reduced mouth opening
  • Underslung jaw

Surgical airway

  • Can’t intubate
  • Distorted anatomy
  • In failed intubation – LMA as bridge between breathing and ventilation

 

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