Dr. Caesar R Okello - The Care of the Multiply Injured Patient

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