Shock in Trauma for paramedics

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Slide 1 : SHOCK IN TRAUMA BY DR.Fiaz Maqbool Fazili SHOCK IN TRAUMA
Slide 2 : WHAT IS SHOCK ?
Slide 3 : SHOCK -Definition SHOCK -is a condition of the circulatory system that results in an inadequate perfusion and oxygenation of tissues.
Slide 4 : SHOCK-TYPES 1.HYPOVOLAEMIC SHOCK Alteration in circulating volume 2.CARDIOGENIC SHOCK Alteration in Cardiac output DISTRIBUTIVE SHOCK Alteration in the peripheral vascular circulation #HYPOVOLAEMIA RESULTING FROM BLOOD LOSSES IS THE MOST COMMON CAUSE OF SHOCK IN TRAUMA PATIENT
Slide 5 : HYPOVOLAEMIC SHOCK WHAT ARE MAJOR CAUSES ?
Slide 6 : Hypovolaemic Shock -Major causes 1.Injuries to CHEST 2.Injuries to the solid organs of the viscera. 3.Fractures of the Femur.(Blood loss can be 1500ml) 4.Fractures of Pelvis. *A# Pelvis can result loss upto 3000ml. BLOOD LOSS FROM ANY INJURY
Slide 7 : HOW TO RECOGNISE SHOCK IN TRAUMA SETTING-
Slide 8 : TRAUMA SITE TRIAGE Category Example 1Immediate Head injury with unequal pulse & developing N-signs 2.Urgent Rupture Spleen Or Pneumothorax 3.Minor Cuts,Bruises,Fractures 4.Palliative 60 yr.Pt +80%Burns 5.DEAD
Slide 9 : TRIAGE AND ITS AIMS PRIORITY- MOST SALVAGAEBLE WITH MOST URGENT CONDITION. IDENTIFY THE MOST SERIOUS ILL PATIENTS FIRST AND ASSURE THEY RECEIVE RAPID CARE. TO DO THE MOST GOOD FOR THE MOST PEOPLE.
Slide 10 : DO,S AND DONOT,S-ABCDE CHECK AIRWAY; Differentiate between a)Complete/Partial obstruction Observe the following-- .Loose Teeth/Foreign bodies .Vomitus .Tongue obstructing airway .Facial and oral bleeding .Soft tissue facial/neck trauma CorrectPosition, Clear and patent airway, Stabilize C-spine
Slide 11 : B-BREATHING-Assessment SPONTANEUS BREATHING RESPIRATOY RATE ,DEPTH ,SYMMETRY ACCESSORY AND ABDOMINAL MUSCLE USAGE. Chest wall integrity Recognize and Act on Life threatening Conditions due to Chest Trauma .
Slide 12 : LIFE THREATENING CONDITIONS(Thoracic causes) Tension Pneumothorax. Open Pneumothorax Flail Chest Massive Hemothorax PERICARDIAL TAMPONADE
Slide 13 : C-CIRCULATION Assess Pulse quality\,location and rate, Assess Capillary refill, Note Skin colour, any source of Bleeding, Assess level of consiousness. NO PULSE:Initiate CPR, BLS,ACLS Pulse present Ineffective
Slide 14 : Pulse is Present- But Ineffective Indicate a life threatening condition, must be assessed quickly. These include; .Decreased level of consiousness .Uncontrolled External bleeding .Distended neck veins .Pale,cool , daiphoretic skin .Decreased capillary refill .Increased Pulse rate, and Decreased quality. Distant Heart sounds
Slide 15 : (C-Circulation) LifeThreateningConditions 1.UNCONTROLLED EXTERNAL BLEEDING.(arterial or venous) Control External Bleeding by; 1.Direct pressure. 2.Pressure over arterial pressure points 3.Elevation in combination with one of the above ,if no Fracture is present
Slide 16 : Circulation-life threatening conditions. 2.SHOCK (Due to Internal or External Bleeding) Signs/Symptoms. .Decreasing level of consiousness .Pale. Cool,Diaphoretic skin. .Delayed capillary refill .Restlessness Increased pulse rate (fright,anxiety ,pain,excitement can cause tachycardia)
Slide 17 : How To Replace Intravascular Volume. Establish I/V Two Large Bore Adults--- (14-16-18)Size Children-as large as possible Type of Fluid; Colloid ;Albumin,Dextran,Plasma Crystalloid; LR,NS,D5w Blood.Uncrossed O negative
Slide 18 : FLUID CALCULATIONS Based on 3:1 rule when using crystalloids e.g; If blood loss is 100 cc, the patient should receive 300 cc of Normal Saline or Lactated Ringers Amount of Fluid Adult;;1-2 Litres Children;20ml/kg Observe Response -act further on this observation
Slide 19 : ADDITIONALCritical POINTS Correctly position the patient Keep the patient warm Apply traction Devcies and Splints. Foley catheter, Nasogastric tube Provide Oxygen Control Bleeding
Slide 20 : Ongoing Assessment- Monitor Level of consious ness Blood Pressure Central venous Pressure Urine output Nasogastric tube
Slide 21 : TRANSPORTATION -GUIDELINES Need to transport to a higher level facility as soon as possible Start Transfer process as soon as possible Stabilize the patient as quickly and effectively Life threatening problems must have intervention BEFORE transport Use appropriate equipment and human resources during transport
Slide 22 : Management whileTransfer-cont Support Cardio Respiratory system(CPRas needed) Continue Blood volume replacement Monitor Vital signs Use meds. as indicated per protocols-ACLS Check that all IV lines/tubes are secured each time the patient is moved Example from site to ambulance to ER or vice versa,
Slide 23 : EQUPIMENTS ENSURE THE APPROPRIATE; IV sets and Cannulas Plastic bottles B.P.apparatus Cardiac Monitor Stethoscopes Drug Basket Intubation Basket. Ambu bags Suction Unit Chest Drain Set Suturing Kits . Dressings Full oxygen tanks Splints HAVE CHECK LIST BEFORE ACT
Slide 24 : COMMUNICATION Maintain communication with receiving hospital en route (example-change in status,estimated time of arrival -ETA) Communication -verbal or written, are necessary parts of the stabilization and transfer process.
Slide 25 : ESSENTIAL INFORMATION Give Receiving Hospital information about. .Age/Sex of Patient. .Mechanism of Injury. .Vital scenes at the scene .Initial findings on assessment. .Procedures performed at the scene. .Response to procedures. .Estimated time of Arrival
Slide 26 : SUMMARY Remember to go through the priorities of PRIMARY SURVEY which are A_B_C_D_E in an organized manner. Try to get a good history and mechanism of injury in order to have a better idea of possible other injuries. Opening the airway AUTOMATIACALLY also means C-spine immobilization.
Slide 27 : SUMMARY /CONCLUSIONS Look.Listen
Slide 28 : CONCLUSION REMEMBER:The goal of therapy is restoration of organ perfusion and adequate tissue oxygenation, signifies by appropriate Urinary output, Central nervous function,Skin colour and return of Pulse and Blood pressure toward normal
Slide 29 : THANK YOU HOPE YOU WERE AWAKE

 


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