2. Causes of Sudden Collapse
• Head Injury / Major Trauma
• Massive Intracranial Event
• Infarct
• Hemorrhage
• Major Myocardial Infarction
• Pulmonary Embolism
• Poisoning
• Oral / Inhaled / Injected
• Insect / Snake Bite
• Chocking
• Convulsion
Dr. Pritesh Vyas (M.D.)
3. History & Clinical Examination
Brief history is important, do not waste more time
Ask for
• Current event
• Past / Present Other Major Illness
• Duration of Collapse / Unconsciousness
Look for
• Level of Consciousness
• Airway
• Breathing
• Pulse
• Cardiac Activity
Dr. Pritesh Vyas (M.D.)
4. The Chain of Survival
American Heart Association (AHA) first proposed the
phrase quot;the chain of survival”
• rapid access to medical care
• early basic life support (BLS)
• early defibrillation and
• early advanced cardiac life support (ACLS).
Dr. Pritesh Vyas (M.D.)
10. Abdominal Thrust in CONSCIOUS Patient
(Heimlich maneuver)
Dr. Pritesh Vyas (M.D.)
11. Unconscious?
SHOUT FOR HELP
• CPR is always best done with more then one
persons
CALL AMBULANCE “108”
• Early initiation of ACLS
• Better infrastructure
• Expert help
Dr. Pritesh Vyas (M.D.)
29. Further Management
• Intravenous access with large bore (20G, 18G)
cannula
• Treat precepitating factor
• Manage Transfer
• Provide Supplemental Oxygen and IV fluids
Dr. Pritesh Vyas (M.D.)
30. List of necessary things
• Telephone
• Torch
• Stethoscope
• AMBU
• Oral / Nasal Airway
• 18 G, 20 G IV cannula
• IV set, Disposible Syringes
• IV fluids
Dr. Pritesh Vyas (M.D.)
34. Triage
The word triage derives from the French word
meaning “to sort.” When applied in a medical
context, triage involves the initial evaluation of a
casualty and the determination of the priority and level
of medical care necessary for the victim. The purpose
of triage is to be selective, so that limited medical
resources are allocated to patients who will receive
the most benefit
Dr. Pritesh Vyas (M.D.)
35. Triage Critaria
• Glasgow Coma Scale of 13 or less
• Systolic blood pressure of 90 or less
• Respiratory rate of 10 per minute or less, or greater than 29 per m
• Sustained pulse rate of 120 per m or more
• Head trauma with altered state of consciousness, hemiplegia, or uneven pupils
• Penetrating injuries of the head, neck, torso, and limbs proximal to the elbow or knee
• Chest trauma with respiratory distress or signs of shock
• Pelvic Fractures OR Two or more proximal long bone fractures
• Amputations above the wrist or ankle
• Limb Paralysis
• Combination of trauma with burns
• Mechanism of Injury and High Energy Impact like
• Fall of 20 feet or more
• Patient struck by a vehicle moving 20 MPH or more
• Patient ejected from a vehicle
• Vehicle rollover with the patient unrestrained
• High speed crash (initial speed of >40 MPH) with 20 inches of major front end deformity, 12
inches or more deformity into the passenger compartment
• Patient was a survivor of a MVA where a death occurred in the same vehicle
Dr. Pritesh Vyas (M.D.)
36. Other Criteria
• Age of less than 5 years old, or over 55 years old
• History of cardiac disease, respiratory disease, insulin
dependent diabetes, cirrhosis, or morbid obesity
• Pregnancy
• Immunosuppressed patients
• Patients with bleeding disorders, or patients on
anticoagulants
• Burns of greater than 30% of body surface area in
adults, or 15% body surface area in children
• Burns of the head, hands, feet, or genital area
• Inhalation injuries
• Electrical burns
• Burns associated with multiple trauma or severe medical
problems
Dr. Pritesh Vyas (M.D.)
37. Glasgow Coma Scale
Feature Response Score
Eye Opening Spontaneous 4
To speech 3
To pain 2
None 1
Vrebal Response Oriented 5
Confused conversation 4
Words inappropriate 3
Sounds incomprehensible 2
None 1
Best Motor Response Obeys commands 6
Localizes pain 5
Flexion normal 4
Flexion abnormal 3
Extended 2
None 1
Dr. Pritesh Vyas (M.D.)
38. ABCDE of Trauma Management
A. Airway maintenance with cervical spine protection
B. Breathing and ventilation
C. Circulation with hemorrhage control
D. Disability; neurologic status
E. Exposure/Environment (completely undress the
patient and prevent hypothermia)
Dr. Pritesh Vyas (M.D.)
39. Initial Evaluation of Trauma
• Level of consciousness
• History
• Clinical Examination
• Haemostasis
• Immobilization
• Supplemental Oxygen if needed
• IV Fluids
• Analgesics, Antibiotics
Dr. Pritesh Vyas (M.D.)
40. Level of Consciousness
CONSCIOUS UNCONSCIOUS
Follow further line of trauma Check for need of CPR
management • YES – Start CPR first
AMPLE Survey
• NO
• Allergies
• Secure Airway
• Medications currently being
taken by the patient • Check Vital Signs
• Past illness and operations • Not Good ? - Correct
first
• Last meal
• Events and Environment
• Good? - Follow
related to the injury further line of trauma
management
Dr. Pritesh Vyas (M.D.)
41. History
• Time of Trauma
• Mode of injury
• Change in level of consciousness
• Amount of blood loss
• Pregnancy – if female
• Other pre-existing medical disorders
• Drug history
• Medicine
• Intoxication – drugs, alcohol, poisons
Dr. Pritesh Vyas (M.D.)
42. Clinical Examination
• Level of consciousness
• Vitals
• General Examination from head to toe
• Quick Systemic Examination
• RS – Air Entry, Chest Movements, Chest
Compression
• CVS – S1, S2, Murmur, Rhythm
• AS – Wounds, Bruises, Distention, Pelvic
Compression
• CNS – GCS, Orientation, Pupils, Limb Movements
Dr. Pritesh Vyas (M.D.)
43. Haemostasis
Control any active visible bleeding with
• Pressure
• Bandage
• Tourniquet
• Pressure Points
• Suture (if possible)
Dr. Pritesh Vyas (M.D.)
44. Key Points in Fracture Management
• Never try to correct deformity yourself
• Apply sterile dressing over open wound
• Haemostasis
• IMMOBILIZATION
• Limbs – any solid slab
• Neck – hard cervical collar
Dr. Pritesh Vyas (M.D.)
45. Supportive Treatment
• Large bore IV line (18 G, 20 G)
• IV Fluids
• Analgesics
• Wound Dressing
• Antibiotics
• Oxygen Support
• Arrange safe transfer
• Police Inform
Dr. Pritesh Vyas (M.D.)
46. Small but important lines
• Never remove penetrating foreign body
• If Female – ask about pregnancy
• Secure IV line – Two lines better
• X-Ray, CT Scan
• Blood Samples – Lab. Tests
• Cross-matching
• Inform Refferal Hospital in advance with proper
records – saves time
• Reassessment
Dr. Pritesh Vyas (M.D.)
47. Critical Trauma Patient
Inadequate or threatened airway
Impaired ventilation as demonstrated by the following:
Abnormally fast or slow ventilatory rate
Hypoxia (Spo2 <95% even with supplemental oxygen)
Dyspnea
Open pneumothorax or flail chest, Suspected pneumothorax
Significant external hemorrhage or suspected internal
hemorrhage
Abnormal neurologic status, GCS score ≤13
Seizure activity
Sensory or motor deficit
Penetrating trauma to the head, neck, or torso. or proximal to
the elbow and knee in the extremities
Amputation or near amputation proximal to the fingers or toes
Dr. Pritesh Vyas (M.D.)
48. Any trauma in the presence of the following
is critical
• History of serious medical conditions
(e.g., coronary artery disease, chronic
obstructive pulmonary
disease, bleeding disorder)
• Age >55
• Hypothermia
• Burns
• Pregnancy
Dr. Pritesh Vyas (M.D.)
