POLYTRAUMA, RTA, MULTIPLE CASUALTIES University Hospital Brno, December 2013 Why are we talking about CPR Overview •Polytrauma/multiple injurie •Traffic incidents •Major incidents/multiple casualties • Terminology •Trauma – external force injury •Polytrauma/multiple injuries in one casualty – injury of one or more systems – e.g. head + chest • • Trauma deaths •First peak •Within minutes of injury •Major neurological or vascular injury •Medical treatment will rarely improve outcome •Second peak •Occurs during the ´golden hour´ •Due to intracranial haematoma, major thoracic or abdominal injury •Third peak •Days or weeks later •Sepsis, multiple organ failure http://healthandfitness101.com/wp-content/uploads/2007/12/whiplash_intro01.jpg Mechanism of injury •Type of injury is related to • how the injury is caused •Look at circumstances in which an • injury was sustained and forces involved •E.g. Side impact more serious versus frontal collision, seat belt? •Whiplash injury • Assessing a casualty •Primary survey •A – Airways and cervical spine •B - Breathing •C – Circulation •D – Dysfunction of the central nervous system •Secondary survey •History •Symptoms •Signs •Definitive treatment – Primary survey –Airways + C spine – Is the airway open and clear? – suspect C spine injury – mechanism –Breathing – Is the casualty breathing normaly? – not breathing? – call 112 + start CPR –Circulation – Is the casulaty bleeding severely? – If the casualty is talking to you, the airway is open and clear http://anesteziseminerleri.com/ahtd_dosyalar/a2.gif Cervical spine •High energy force – always suspect cervical spine injury •If airway compromised initially attempt a jaw trust and clear airway of foreign bodies 4 4 4EMS 4100% Oxygen 4Secure Airway •(Intubate, Laryngeal Mask ..) 4 Do not move the casualty unless – 4Not moving them would be an immediate threat to their life. 4They are vomiting. 4They are choking on blood. 4You need to check for breathing – – Cervical spine stabilization •Manual In Line Stabilization - MILS http://upload.wikimedia.org/wikipedia/commons/b/bb/LateralCollar.JPG Cervical spine stabilization 4If you HAVE to move a person you suspect has a neck injury, 4keep their head and neck immobile and move their entire body as one unit. • B - breathing – 4Check position of trachea, respiratory rate and air entry 4If clinical evidence of tension pneumothorax will need immediate relief 4 4EMS 4Place venous cannula through second intercostal space in the mid-clavicular line • – – Open chest wound [USEMAP] C - circulation – 4Assess pulse and capillary return 4Identify severe bleeding and apply direct pressure 4 •EMS 4Place two large calibre intravenous cannulas Give intravenous fluids (crystalloid or colloid) 4Attach patient to ECG monitor • – – D – dysfunction of CNS – •Assess level of consciousness using AVPU method A = alert V = responding to voice P = responding to pain U = unresponsive • •Assess pupil size, equality and responsiveness • – – Secondary survey •History • A - Allergies • M - Medication • P – Past medical history • L – Last meal and drink • E – event history •Symptoms – what the casualty tells you about •Signs - what you can see, hear, feel, head to toe examination • – – Multiple casualties •several casualties at the same time • •1. Call EMS ▫Type of incident – fire, traffic incident, explosion ▫Location , access, any paticular hazards, aproximate number of casualties •2. Assess the scene - without putting your safety at risk •3. Triage 'do the most for the most' • – – Triage 4Ability to walk 4Cannot walk 4Walking – injured, uninjured 4 4Airway 4Respiratory rate 4Pulse rate or capillary return • – – Traffic incidents •fall from a bicycle …. major incident with many casualties •serious risks to • safety - traffic • – – 1. Danger – Safety first •protect yourself, the casualty and other road users –Park your car safely, turn lights on, set hazard lights flashing, high-visibility vest –Do not across a busy motorway to reach other side –Set others to warn other coming drivers –Set up warning triangle 50 metres from the incident –Make vehicles safe – switch off ignition of any damaged vehicle, Is anyone smoking? –Stabilize vehicles – handbreak, gear in • – – 2. Assess – check all casualties 4quick assessment – primary survey 4no moving 4apply life-saving treatment • – – 3. Treat 4in the position found 4first life-threatening or potentially serious injuries • – – 4. Search of area •To be sure you don´t overlook any casualties who may have been thrown clear or wandered away from the site • – – Questions ? ana_1_075_anaphylaxis_13_01_med