Managing trauma

44 Managing trauma





Questions



image What is the primary survey?

image What is the secondary survey, and when is it commenced?

image How can you control an airway?

Management of major traumas arriving in hospitals is standardized so that the team’s priorities in the initial care of the patient are set and nothing is missed.




The primary survey


The initial management is with ABC:


A: airway (with cervical spine control)

B: breathing with ventilatory support

C: circulation with haemorrhage control.

Also consider:


D: dysfunction (neurological status)

E: exposure.

The primary survey is repeated until the patient is stable. Only then are radiographs and the secondary survey initiated.



Airway


The first step in evaluating and treating any trauma patient is to assess airway patency and, if compromised, restore it. If the patient can speak, this suggests a patent airway.


Stridor is indicative of upper airway obstruction. Obstruction such as the position of the tongue, a foreign body or vomit is assessed. The tongue is controlled with adjuvants (see below) and foreign objects are removed with suction or Magill forceps. All patients should be given 100% oxygen at 15 l/min.


Management of the airway


image simple measures
— chin lift, jaw thrust manoeuvres

— Guedel airway

— nasopharyngeal tube

image definite airway (Fig. 3.44.1)
— endotracheal intubation: orotracheal, nasotracheal

— surgical airway: cricothyroidotomy; this is a last resort and is only effective for 30–45 min.

image

Fig. 3.44.1 Airway management with an endotracheal tube.


Indications for a definitive airway are:


image the presence of apnoea

image inability to maintain a patent airway by less-invasive means

image to protect the lower airway from aspiration of blood or vomitus

image impending or potential airway compromise (e.g. following inhalational injury, facial fractures)

image presence of a closed head injury requiring assisted ventilation

image inability to maintain adequate oxygenation by face mask oxygen supplementation

image any patient with a Glasgow Coma Score (GCS) of 8 or less; see Ch. 72) will have loss of airway protective reflexes (e.g. gag reflex).
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Managing trauma

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