Injury
•Damage of tissues, organs and organ systems
•Caused by external forces
•Mechanical, physical, chemical
•Monotrauma…polytrauma, life threatening
•Life-limb-function
•Influence on working and social life
•Most common cause of death under 40years of age

Anamnesis
•Common medical history :
•                            risk factors
•                            general status (morbidity, mortality)
•                                              drugs, allergies
•                            pregnancy
•Mechanism of injury:
1.Approximation of injury severity -  triage
2.Approximation of type of injury

AMPLE + MIST
•Allergies
•Medication
•Present medical history
•Last meal
•Events related to injury
•Mechanism of injury
•Injuries find and suspected
•Signs + Symptoms
•Treatment initiated

Triage criteria of polytrauma
•Mechanism of injury
○Falls > 6 meters (second floor)
○High risk auto crash (ejection, intrusion, death of another passenger, telemetry)
○Motorcycle crash > 30 km/h
○Auto vs. pedestrian/bicyclist > 30 km/h
•Consider special conditions
○Age < 6y or > 55y
○Cardiopulmonar comorbidity
○Pregnancy
○etc
•
•
•Vital signs and level of consciousness
○GCS < 13
○Systolic blood pressure < 90
○Respiratory rate < 10 or  > 29 (or need for ventilatory support)
•Anatomy of injury
○All penetrating injuries
○Pelvic fractures
○Two or more proximal long-bone fractures
○Crushed, degloved, mangled, or pulseless extremity
○Amputation proximal to wrist or ankle
○Open or depressed skull fracture
○Paralysis
•

Mechanism       type of injury



Associated trauma:
•1st-3th rib…plexus brachialis, a.et v.subclavia, trauma of thoracic aorta (disection)
•Scapula fracture – high energy trauma
•Rib fracture in middle part…lung contusion…ARDS, PNO, hemothorax…
•Distal ribs… liver, spleen
•Pelvis…rectum, urinary bladder, venous plexus

Injuries:
•Superfitial, deep, penetrating
•Open, close
•Soft tissues, skeletal trauma
•
•Monotrauma
•Combined trauma
•Polytrauma

Fyzik. vyšetření
•Primary survey ABCDE
•Secondary survey
•Targeted excamination
•
•Simple…. complex
•
•Physdical examiination

Physical examination
●I am a people person really...
●Inspection
●Auscultation
●Palpation
●Percussion
●Rectal exam
●

Inspection
•Swelling
•Hematoma, bleeding
•Wound
•Defiguration, devition of extremities
•Breathing movements
•Skin charakter (cyanosis, sweating, paleness)
•Foreign bodies
• ……

Auskultation
•Heart sounds
•
•Lungs
•
•Abdomen

Palpation
•pain
•Creppitation, fluctuation
•Emphysema
•Pathological movement
•Peritoneal irritation
•….
•
•Extremities: neurocirculation!!!!
•

Percussion
•Lungs
•
•Abdomen
•
•Soft tissues

Rectal exam?



Specific clinical syndromes
•Beck´s trias: hypotension, increased load of cervical veins, decreased heart sounds
•Hypotension, tachykardia, increased load of cervical veins, decreased breathing sounds
•Kehr´s sign
•Lucid interval
•Hypertension, bradykardia, decreased GCS
•
•……………

Battle´s sign & Racoon eyes
Obsah obrázku zvíře, savci, osoba, interiér Popis se vygeneroval automaticky. Obsah obrázku osoba,
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Fractures
•Certain signs:
•
•Visible bone – open fracture
•Deformity
•Pathological movement
•Creppitation
•Uncertain signs:
•
•Pain
•Swelling
•Damaged function


















































































Thank you for attention