MEKELLE UNIVERSITY

COLLEGE OF
HEALTH SCIENCES
DEPARTMENT OF SURGERY
C1 SEMINAR on
APPROACH TO TRAUMA

Prepared by :
1. Kifle
2. Nahom
Moderator : Dr.
Tsegay
Outline

 Introduction
 Burden of trauma
 Classification of trauma
 Mechanism s of trauma
 Primary trauma care

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Introduction
 Trauma or injury has been defined as damage to the body
caused by an exchange with environmental energy that is
beyond the body's resilience.
 Trauma remains the most common cause of death for all
individuals between the ages of 1 and 44 years and is the
third most common cause of death regardless of age.

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Epidemiology- Trauma in the US

 Leading cause of death in < 45 age group

Blunt trauma accounts for 80% of mortality in the <

34 age group

12% of all hospital beds are occupied by trauma

patients

$400 billion loss in income due to death and disability

annually

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classification
 Blunt
 Penetrating
 Blast
 Crush
 thermal

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trimodal death distribution
Immediate Early late

% 50 30 20
causes Extensive Impending air Sepsis and
brain injury, way multi organ
large vessel obstruction, failure
disruption increasing IC
bleeding

Management Prevention of Primary Secondary

RTA…. survey and survey and
resuscitation definitive
management

September 8, 2025 6
PRIMARY TRAUMA CARE
 Triage
 Primary survey
 Secondary survey
 Definitive management

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Basics Of PTC
 Preparation
 Team Assembly
 Equipment Check
 Triage
 Sort patients by level of acuity (SATS)
 Primary Survey
 Designed to identify injuries that are immediately life
threatening and to treat them as they are identified
 Resuscitation
 Rapid procedures and treatment to treat injuries found in
primary survey before completing the secondary survey
 Secondary Survey
 Full History and Physical Exam to evaluate for other traumatic
injuries
 Monitoring and Evaluation, Secondary adjuncts
 Transfer to Definitive Care
 ICU, Ward, Operating Theatre, Another facility
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Triage
 It is the classification of patients based on their need to
treatments and available resource for that treatment.
Priority Colour Medical need Clinical status

Critical, but likely to survive if treatment

First (I) Red Immediate
given early

 .
Critical, likely to survive if treatment
Second (II) Yellow Urgent given
within hours

Stable, likely to survive even if

Third (III) Green Non-urgent treatment
is delayed for hours to days

Not breathing, pulseless, so

severely
Unsalvage
Last (0) Black injured that no medical care
able
is likely to
help

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Primary Survey:

 Key Principles
 IDENTIFY AND THREAT WHAT IS KILLING THE
PATIENT.
 If the patient gets worse, restart from the
beginning of the primary survey
 ABCDEs of trauma care
 A Airway and c-spine protection
 B Breathing and ventilation
 C Circulation with hemorrhage control
 D Disability/Neurologic status
 E Exposure/Environmental control

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Airway assessment
.objective is to identify obstruction and injuries to the
airway and act immediately.
How to asses?
● Identify yourself
● Ask the patient his or her name
● Ask the patient what happened
● Appropriate Response Confirms;-


A Patent airway

 B Sufficient air reserve to permit speech

 C Sufficient perfusion to permit cerebration

 D Clear sensorium
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Airway ……..
 Evaluating for airway patency
 Look for sign of airway
obstruction(snoring, stridor or
hoarseness)
 inspecting for foreign bodies
including lost tooth;
 Look for back fall of tongue
 identifying facial, mandibular,
and/or tracheal/laryngeal fractures
 Inspect for accumulated blood or
secretions

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 Maintenance of Airway Patency
 Suction of Secretions
 Chin Lift/Jaw thrust
 Nasopharyngeal Airway
 Oropharyngeal airway
 Definitive Airway;endotracheal intubation ,surgical
chricothyroidotomy
Breathing and Ventilation
Breathing/Ventilation Assessment
Assess and ensure adequate oxygenation and ventilation
 Air movement

 Respiratory rate
 General Inspection
 Accessory Muscle Use
 Retractions
 Absence of spontaneous breathing
 Paradoxical chest wall movement
 Open chest wound
 Auscultation to assess for gas exchange
 Equal Bilaterally
 Diminished or Absent breath sounds
 Palpation
 Deviated Trachea
 Broken ribs
 Injuries to chest wall
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BREATHING
BEWARE

 Tension pneumothorax
 Massive haemothorax
 Open pneumothorax
 Flail(Hit) chest
 Lung contusion (bruise)
BREATHING
MANAGEMENT
 Oxygen (if available)at high flow rate
for all the injured.
 Artificial ventilation
 Decompress pneumothorax
immediately with needle at 2nd ic mid
clavicular
 For open pneumothorax
 Drain haemothorax
Circulation and Hemorrhage Control

Assessment;palpation of peripheral
pulses give a
good clue abt the circulation.
Pulsses are palpable 60mmhg,70mmhg,80mmhg for
carotid,femoral,radial pulses.
 Volume and quality of the pulses and the BP
 The level of consciousness;hypoxia=agitation
 Skin temperature and color
 Nail bed capillary refill time .

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 Management
 Measure bp and pulse manually every 5
minute till vs are restored.
 Stop bleeding;hypotension is caused
by hemmorahe till proven otherwise
 Large bore intravenous access x 2
peripheral catheters
 Blood for crossmatch and Hb
 Administer IV fluid
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CIRCULATION
BEWARE

 Intra-abdominal injury
 Intra-thoracic injury
 Long bone fracture
 Pelvic fracture
 Penetrating injury
 Scalp wounds
Pericardial Tamponade
Pericardium or sac around heart fills
with blood due to penetrating or
blunt injury to chest
Beck’s Triad
Distended jugular veins
Hypotension
Muffled Heart Sounds
Treatment
Rapid evacuation of pericardial space
Performed through a
Pericardiocentesis (temporizing
measure)
Open Thoracotomy
Fluid and blood resuscitation

 Initial fluid resuscitation for these patients often

consists of a bolus of intravenous crystalloid (eg, 20
mL/kg isotonic saline)
 Patients with obvious severe or ongoing blood loss
should be transfused immediately with type O negative
blood.
 Patients who do not improve should receive cross-
matched packed RBCs with more fluids.
Asses the response
 Clinical status
 Vital signs
 Input output ratio

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Circulation
 Shock
 Impaired tissue perfusion
 Tissue oxygenation is inadequate to meet metabolic demand
 Prolonged shock state leads to multiorgan system failure and cell death
 Clinical Signs of Shock
 Altered mental status
 Tachycardia (HR > 100) = Most common sign
 Arterial Hypotension (SBP < 90)

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Circulation
 Inadequate Tissue Perfusion
 Pale skin color

 Cool clammy skin

 Delayed cap refill (> 3 seconds)

 Altered LOC

 Decreased Urine Output (UOP < 0.5 mL/kg/hr)

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Potential site of bleeding to extent of
causing hemorrhagic shock
 Chest (Hemothorax, Aortic injury)
 Abdomeno pelvic
 penetrating or blunt abdominal injury
 Pelvic bone fracture
 Retroperitoneal bleeding
 Long bone fracture ( e.g femoral shaft
fracture)
 External bleeding

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Physiologic class of hemorrhage

paramete Class I Class II Class III Class IV

r
Approxima <15% 15-30% 30-40% >40%
te blood (<750 ml) (750 -1500 (1500- (>2000
lose ml) 2000 ml) ml)
Pulse rate <100 100-120 120-140 >140

Blood normal normal decreased decreased

pressure
Pulse normal decreased decreased decreased
pressure
Respirator normal normal Tachypnea tachypnea
y rate
Mental normal Agitated Confused Stupor to
status coma
Need for No need possible yes Massive 26
Circulation
 Emergency Nursing Treatment
 Two Large IV Lines
 Cardiac Monitor
 Blood Pressure Monitoring
 General Treatment Principles
 Stop the bleeding
 Apply direct pressure
 Close open-book pelvic fractures
 Abdominal pelvic binder/bedsheet
 Restore circulating volume
 Crystalloid Resuscitation (2L)
 Administer Blood Products
 Immobilize fractures

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Response assessment for initial resuscitation

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Disability

Perform a quick neurologic examination and assess

 The patient's level of consciousness using GCS
 Pupillary size and reaction
 Gross motor functioning.

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Exposure / Environment
Completely undress the patient

Cauti
Prevent
on
hypother
mia

Pitfall
Missed
s
injuries
Trauma Logroll
 One person = Cervical Spine
 Two people = Roll main body
 One person = Inspect back and palpate spine

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Adjuncts to Primary
Survey

Vital signs
ECG

PRIMARY
SURVEY Pulse
Urinary
oximeter
output
and CO2
Urinary / gastric catheters
unless contraindicated
Secondary Survey
 Secondary Survey is completed after primary survey is
completed and patient has been adequately resuscitated.
 No patient with abnormal vital signs should proceed
through a secondary survey
 Secondary Survey includes a brief history and complete
physical exam

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History
 AMPLE History
 Allergies
 Medications
 Past Medical History, Pregnancy
 Last Meal
 Events surrounding injury, Environment
 History may need to be gathered from family members or
ambulance service

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Physical Exam
 Head/HEENT
 Neck
 Chest
 Abdomen
 Pelvis
 Genitourinary
 Extremities
 Neurologic

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Adjuncts to Secondary Survey
 Radiology
 Standard emergent films
 C-spine, CXR, Pelvis
 Focused Abdominal Sonography in Trauma (FAST)
 Foley Catheter
 Blood at urethral meatus = No Foley catheter
 Pain Control
 Tetanus Status
 Antibiotics for open fractures

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Definitive Care
 Secondary Survey followed by radiographic evaluation
 Ct Scan
 Consultation
 Neurosurgery
 Orthopedic Surgery
 Vascular Surgery
 Transfer to Definitive Care;hemodynamic and cvs tability
required
 Operating Room
 ICU
 Higher level facility

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