The Care of the Multiply Injured Patient Dr. Caesar R Okello, MBChB, MBChB, MMed. MMed. (Surgery) General, Trauma and Critical Care Surgeon 1.3 M deaths per year ‘Vulnerable Road Users’ Pedestrians, cyclists, motorbikes a/c for 50% of deaths 20 20--50 M injuries non fatal LIC, MIC a/c for 90% of fatalities Source: WHO 2009 Global Status Report on Road Safety Host Agent Environ Injury Systems approach to Road safety Injury Prevention Engineering: Host, Environment Legislation: Enforceable laws Enforcement: Police, Community Education: Agent: Road users, Police, *Learners *Safe Kids, TTT Injury Prevention • 10,000 students • Acer Arena www.australianyouthandroadtraumaforum.org Injury Prevention Pre--hospital Care Pre Call Centre: Ambulance, Fire, Police Equipped Ambulances Trained Personnel BLS, ALS Protocol Based Interventions, Triage Tools Designated Trauma Centres The Golden Hour Pre--hospital Care Pre M Mechanism of injury I Injuries observed S T Therapy administered ABCD In In--hospital Trauma Care Trauma Centres Trauma Centers Adams Cowley, July 27, 1917- October 27, 1991 In In--hospital Trauma Care Trauma Centre Resourced Accident and Emergency Unit Trauma Teams Trauma Surgeons (ATLS accredited), O.R. Multidisciplinary team Intensive Care facilities Trauma call Criteria Pre Pre--hospital Mechanism Clinical findings Others Pre--hospital Pre SBP < 90 PREGNANT > 20 WEEKS COMBATIVE PATIENTS AGE > 65 + ANY OTHER STABLE CRITERIA Mechanism PENETRATING TRAUMA – HEAD/NECK/TORSO/LIMBS BURNS > 20% 20% Death in the vehicle, ejection Clinical THREATENED AIRWAY INTUBATED OR ATTEMPTED INTUBATION BREATHING DIFFICULTIES Clinical RESPIRATORY RATE < 10 or 30/min SBP < 90 PULSE RATE < 50 or > 110/min GCS < 14 Clinical SPINAL CORD INJURY LIMB AMPUTATION MAJOR CRUSH INJURY FLAIL CHEST MAJOR PELVIC INSTABILITY Others > 3 ADMISSIONS SIMULTANEOUSLY >8 OR MORE ADMISSIONS + DISASTER PLAN Primary survey A Airway and CC-Spine protection B Breathing, Ventilation C Circulation D Disability (Neurological evaluation) E Exposure Imaging Primary survey Primary survey Adjuncts Monitoring Catheters (urinary, gastric) Diagnostic studies CPC, DPL, FAST Pelvic binder? Adjunct procedures Secondary survey Head to toe exam, log roll, fingers in all orifices Secondary survey Head, Skull Maxfacial Maxfacial,, intraoral Neck Chest Abdomen, Pelvis Perineum MSK External Neuro Adjuncts CT Extremity XX-rays Endoscopy USS/Echocardiography Definitive care Appropriate Intervention Imaging Tertiary survey Post Acute Care Allied Health Dieticians Speech Therapy Social Workers Physiotherapy Occupational therapy Rehabilitation Pastoral care Re Re--integration