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Initial Assessment of the Trauma and Burn Patient Don Reiff, MD Assistant Professor, Section of Trauma/Burns/Critical Care Surgery Clerkship Director
Magnitude of the Problem ,[object Object],[object Object],[object Object],[object Object],[object Object]
Magnitude of the Problem ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma/Burns Resuscitation ,[object Object],[object Object],[object Object]
Trauma/Burns Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma/Burns Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],What are the goals of the primary survey?
Trauma/Burns Resuscitation ,[object Object],[object Object],Should airway control be necessary, what is the best means?
Trauma/Burns Resuscitation ,[object Object],[object Object],[object Object]
Trauma/Burns Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Life-Threatening Chest Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Life-Threatening Chest Injuries ,[object Object],[object Object]
Life-Threatening Chest Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Life-Threatening Chest Injuries ,[object Object],[object Object]
Life-Threatening Chest Injuries ,[object Object],[object Object],[object Object]
Trauma Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Non-hemorrhagic
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],What about patients who don’t respond appropriately to our initial fluid bolus? ,[object Object],Q=  Pr 4 8  l ,[object Object],[object Object],[object Object],[object Object],[object Object],Q=  Pr 4 8  l
Algorithm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Algorithm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to the Evaluation of Shock ABC’s Intubate Tachycardic/hypotensive/ hypoxic w/ absent BS Needle decompression w/ concurrent fluid resuscitation No rush of air/vital signs show no improvement “ Non-responder” Go through check list of etiologies
Case Presentation ,[object Object],[object Object],[object Object],[object Object],Non-hemorrhagic sources - Sepsis - Cardiogenic - Neurogenic - Obstructive
Approach to the Evaluation of Shock Primary survey Needle decompressed/volume resuscitation Non-responder - Sepsis - Cardiogenic - Neurogenic - Obstructive Eliminated CXR has ruled out Tension pneumothorax Use ultrasound to rule out pericardial tamponade All that remains is hypovolemic/hemorrhagic shock
Approach to the Evaluation of Shock ,[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],In addition to auto-transfusion, 4u pRBC’s given slowing HR to 130’s and SBP improves to 115 Repeat ABG finds 7.26/38/135/-9/9.2
Case Presentation ,[object Object]
Case Presentation ,[object Object]
BURNS
Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Presentation ,[object Object],[object Object],[object Object],[object Object]
Severity of Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]
Burn Depth
Burn Depth ,[object Object],[object Object],[object Object],[object Object]
 
Burn Depth ,[object Object],[object Object],[object Object],[object Object]
 
Burn Depth ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Burn Depth ,[object Object],[object Object],[object Object],[object Object]
 
Extent of Burn ,[object Object],[object Object]
 
Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Escharotomy ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Inhalation injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inhalation injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Carbon Monoxide ,[object Object],[object Object],[object Object]

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ITTABV1

  • 1. Initial Assessment of the Trauma and Burn Patient Don Reiff, MD Assistant Professor, Section of Trauma/Burns/Critical Care Surgery Clerkship Director
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  • 23. Approach to the Evaluation of Shock ABC’s Intubate Tachycardic/hypotensive/ hypoxic w/ absent BS Needle decompression w/ concurrent fluid resuscitation No rush of air/vital signs show no improvement “ Non-responder” Go through check list of etiologies
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  • 25. Approach to the Evaluation of Shock Primary survey Needle decompressed/volume resuscitation Non-responder - Sepsis - Cardiogenic - Neurogenic - Obstructive Eliminated CXR has ruled out Tension pneumothorax Use ultrasound to rule out pericardial tamponade All that remains is hypovolemic/hemorrhagic shock
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