Trauma 1st Day
August 9, 2010
Sign of life ” CPR “
• Cardiac Activity
• Pupil, Pulse
• Respiration
ISS = Injury Summary Score (max 75)
If > 15 –> multiple injury
> 25 –> coma
Ps = Percent of survival
SSI = Superficial / Deep / Organ
TAI = Traumatic Aortic Injury
Ant Abdominal Wound –>
-First: V/S –> stable/unstable –> penetrate sheath? –> yes: wound exploration
-Investigate: FAST, CT, DPL
Diagnostic Peritoneal Lavage (DPL) Indications -
1.unconcious patients with concerns of a potential abdominal injury
2.high-energy injuries, suspected intraabdominal injury and non-specific abdominal physical findings
3.multiple injuries with unexplained shock
4.thoracoabdominal injuries
5.spinal cord injuries
6.intoxicated patients with suspected intraabdominal injuries
contraindication –> obvious indication for exploratory laprarotomy
-presence of free air
-peritonitis
-isolated penetrating trauma from a gunshot wound
-pregnancy
-morbid obesity
Positive–> 10 cc gross blood
if not positive –> push NSS 2 litres and draw at least 30% back to microscope
Blunt – RBC 100,000, WBC 500 or presence of enteric matter
Penetrate – RBC 10,000
FAST - u/s
1.hepatorenal
2.splenorenal
3.cul-de-sac
4.epigastrium
Film CXR “ABCD”
-Airway –> trachea shift?
-Bone –> Ribs Fx
-Cardiac –> widening mediastinum = at the site of carina and the width is >8cm (mediastinum = heart/aorta/trachea/esophagus/)
-Diaphragm –> anterior ribs 6th, posterior ribs 9th
-Equipment –> ET tube 5cm above carina +/- 2cm
–> CVP at bronchus intermedius (Rt main bronchus)
–> ICD at the sentinel is in pleura
