32. Primary and secondary survey when dealing with trauma patients (also when to operate) Flashcards
- Primary and secondary survey when dealing with trauma patients (also when to operate)
Trauma
-a wound or an injury
-blunt/penetrating
-may occur secondary to several events
-severity can range from undetectable to fatal
-may affect one or multiple organ systems
-initial approach often makes the difference in the eventual outcome
-primary survey
-secondary survey
Primary and secondary survey
-without excess time-wasting
-Primary survey
1)assessment of the respiratory and cardiovascular systems
2)assessment of the central nervous system and urinary track system
-secondary survey
3)assessment of all other systems once the immediately life-threatening problems(identified during primary survey)are dealt
with
Critically ill trauma patient(primary survey)(A-B-C-D)
-Airways
>patent airway– intubation if necessary
-Breathing
>RR,pattern,auscultation, imaging–thoracocentesis if necessary(before imaging!)
>oxygen support!!
-Circulation
>mucous membranes,CRT,HR(auscultation)+pulse,hemorrhage?(imaging),IV catheter(+ blood sample),BP
>IV fluids!!(treatment of shock)
-Disability(neurologic evaluation)
>consciousness,MGCS,voluntary motor function,reflexes,deep pain etc.
After primary survey and initial stabilization
-continued monitoring and systemic treatment!(analgesia!)
-full medical history including:
>time of traumatic event
>specific signs of illness after trauma(and progression!)
>current medications
>allergies to foods or medications
>previous history of blood transfusion
-secondary survey
>complete physical examination
>identification of all trauma-associated injuries
Further diagnostics and treatment
-preferrably once the patient is stable
-in case the patient is deteriorating
-clinical examination!
-diagnostic imaging
-symptomatic/specific treatment
-each case is different
To operate:
-trauma-associated mediastinal injuries:tracheal avulsion
-diaphragmatic hernia
-abdominal trauma:
>surgery indicated in case:
*evidence of septic peritonitis
*any form of penetrating injury
*evidence of unremitting intraperitoneal hemorrhage
*any evidence of a traumatic body wall hernia that contains herniated abdominal viscera
>decision to operate:after stabilization/deteriorating patient
-uroperitoneum
-trauma-associated biliary tract injury
-trauma-associated gastrointestinal injury
