ABC OF TRAUMA

Dr.M.H.J.Ariyaratne
Consultant Surgeon
Head / Department of Surgery
Trauma is the commonest cause of
mortality and morbidity among the
young population.

The initial evaluation of a person who is
critically injured from multiple trauma is
challenging and every minute can
make the difference between life and
deaths.

Advanced Trauma Life Support

Primary survey,resuscitation and
reassessment.
Secondary survey, management and
monitoring.
Definitive management.

PRIMARY SURVEY

A-AIRWAY AND CARE OF CIRVICAL
SPINE

B-BREATHING

C-CIRCULATION AND CONTROL OF
HAEMORRHAGE

D-DISABILITY OF CNS

E- EXPOSURE

F- FLUID AND FOLEY CATHETER

G- GASTRIC DECOMPRESSION
AIRWAY

The airway is the first priority.
Some causes for airway obstruction
are,
Unconsciousness( GCS<8)
Aspiration of vomitus or blood
Foreign bodies in airway.
Injury to face/ neck/ upper chest
Secure the airway.

Give O2.

Control and stabilize the cervical
spine.


Breathing
Evaluate breathing by checking the
chest wall movement, rate and depth
of respiration
Some critical findings are,
absence of spontaneous breathing,
reduced respiratory rate, paradoxical
chest wall movements, absent or
asymmetric breath sounds.

Immediately life threatening
thoracic conditions
Air way obstruction
Tension pneumothorax
Cardiac temponade
Flial chest
Haemopneumothorax
Tension pneumothorax
Flail chest
How to assess circulation?

General Pallor
State of dehydration
Distressed patient
CVS Peripheral pulses
Blood pressure
CVP line
Urine volume
Insert two wide bore cannulae.
Commence fluid resuscitation
Take blood for investigations and
grouping & cross matching.


Disability
Quick neurological assessment is
done by AVPU method.
A- Alert
V- Responds to vocal stimuli
P- Responds to painful stimuli
U- Unresponsive
Exposure

Completely remove the patients
clothes .

This will help for a thorough physical
examination during secondary survey.
Secondary survey
Identify all injuries by conducting a full
head to toe and front to back
examination.
Level of consciousness is assed by
Glasgow coma scale.

AAMPLE history

A- Allergy
A- Addiction
M- Medication
P- Past illnesses
L- Last meal
E- Event and Enviroment
Glasgow Coma Scale
Developed by Jennett and Teasdale.

Verbal response.
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
Nil 1

Glasgow coma scale cont
Motor function
Obeys 6
Localization 5
Withdraws 4
Abnormal flexion 3
Extends 2
Nil 1
Eye opening
Spontaneous 4
To speech 3
To pain 2
Nil 1

Management of spinal cord injuries.

All the multiply injured
patients should be
suspected of having
spinal cord injury.
Examination of such
patient should be done
with caution.
LOGROLLING method
is used to manage
such condition.


LOG ROLLING METHOD
Whole patient
should be handled
as a single piece.
Cervical collar,two
sand bags and
neck stripers are
needed.
At least five people
are needed to
handle the patient.
Brain injuries
Primary Brain Injury
Caused at the time of impact and is
irreversible.
Example:
Cortical contusion
Diffuse axonal injuries
Brains stem contusions
Extra dural haemorrhage
Secondary Brain Injury
develops subsequent to the impact
damage.
Example:
Cerebral oedema
Hypoxaemia
Infection
Epilepsy
Prevention of secondary brain damage
Oxygen therapy
Antibiotics for open fractures
Anticonvulsants to control fits
Avoid fluid overload
Temperature control


Detailed history, physical condition of
the patient and all steps that were
taken in the ward should be
documented and given to the patient
before he/ she leaves the hospital.
THANK YOU.