ABCD approach - D - disability assessment and early management to save life of traumatized patient

1. BY
DR. AHMED ABDELTAWAB AZAB
Emergency Consultant
American Heart Association Instructor
Emergency lecturer

3. Definition.
• Disability: any problem could affect pt. life or
limb threat or affect prognosis and out come.
• Types:
– Neurological.
– Metabolic.

4. Assessment
• Assessment of neurological statues of any pt.
done during primary survey by
• Use GCS score
• Use AVPU score.
• Pupil size.

8. AVPU score
• Easy applicable.
• Easy remembering.
– A – Alert.
– V – respond to Verbal stimulation
– P – respond to Painful stimulation.
– U – Unresponsive
• P score equal 8 score in GCS.
• U score equal 3 – 7 score in GCS.

10. Pupil examination
• Normal pupil with coma exclude intracranial
hemorrhage but dose not exclude toxicity.
• Bilateral constricted: pin point pupil:
• Organophosphorus toxicity.
• Opiate toxicity – heroin – cocain.
• Pontine hge.
• Bilateral dilated fixed pupil: brain death.
• Bilateral dilated reactive pupil:
• Hallucination drugs – amphetamin

11. Pupil examination

12. Pupil examination.
• Unilateral dilated pupil:
• Intracranial hge : subdural hge .

13. Quiz

14. Convulsions
• Febrile convulsions
• Children 1 – 5 years
• Simple epilepsy
• Less than 5 minutes – regain full consciousness
• Status epilepticus
• More than 5 - 15 minutes
• Not regain consciousness fully between attack

15. Convulsions
• At home management:
– Protect air way – left lateral position
– Need for neck collar ??
– Protect from head trauma
– Close light
– Quit environment.
– Post epilepsy state – recovery position.
– Safe transfer.

16. Convulsions
• Medication:
– Oral – buccal Lorazepam ½ wt
– Rectal diazepam ½ wt.
– IV midazolam 1/10 wt
– Maximal attempts is twice 20 min. apart.
• Antipyretic and fomentation may help in
febrile convulsion

17. Convulsions
• At hospital:
– The same like home 1st 2 doses.
– If recurrence: start phenytoin – epanutin infusion
• 20 mg / kg IV over 30 – 60 minutes
– If recurrence: intubation and general anesthesia.
– Extra investigations.

18. Metabolic Emergencies:
• Hypoglycemia:

19. Hypoglycemia:
• Management:
–Protect airway
–If conscious – oral glucose.
–If drowsy or unconscious with IV access:
–IV dextrose: 50% - 25% - 10% - 5%
–If drowsy or unconscious without IV
access:
–IM glucagon

20. Hyperglycemia and DKA

21. Hyperglycemia and DKA
• Management:
–Fluid
–Fluid
–Fluid
–Insulin
–Admission.

22. Intoxicated patient.
• Do not forget.
– Safety for you.
– Safety for the patient.
– Airway protection.
– Decontamination
– Rapid transportation.
– Antidote.

23. Intoxicated patient.
• Organophosphorus:

24. Organophosphorus
• Management:
– Airway – open and suction
– Breathing – high flow O2 – intubation.
– Circulation – IV access.
– Disability – constricted pupils.
– Exposure – decontamination
– Antidote – atropine IV ??

29. Nasogastric
tube is
contraindicated

30. Warfarin
antidote is
vitamin K

33. Ethylene glycol
‫السيارات‬ ‫راديتير‬ ‫مبرد‬
Ethanol
Hemodialysis