Management of traumatized patient

Posted by e-Medical PPT
Immediate treatment of airway obstruction in facial injured patient
Clearing of blood clot and mucous of the mouth and nares and head position that lead to escape of secretions (sit-up or side position)
Removal of foreign bodies as a broken denture or avulsed teeth which can be inhaled and ensuring the patency of the mouth and oropharynex
Controlling the tongue position in case of symphesial bilateral fracture of mandible and when voluntary control of intrinsic musculature is lost
Maintaining airway using artificial airway in unconscious patient with maxillary fracture or by nasophryngeal tube with periodic aspiration
Lubrication of patient’s lips and continuous supervision

Additional methods in preservation of the airway in patient with severe facial injuries
Endotracheal intubation
    Needed with multiple injuries, extensive soft tissue destruction and for serious injury that require artificial ventilation

Tracheostomy
    Surgical establishment of an opening into the trachea
    Indications: 1. when prolonged artificial ventilation is necessary
                                2. to facilitate anesthesia for surgical repair in  certain cases
                                3. to ensure a safe postoperative recovery after extensive surgery
                                4. following obstruction of the airway from laryngeal edema
                                5. in case of serious hemorrhage in the airway

Circothyroidectomy
    An old technique associated with the risk of subglottic stenosis development particularly in children. The use of percutaneous dilational treachestomy (PDT) in MFS is advocated by Ward Booth et al (1989) but it can be replaced with PDT.

Control of hemorrhage and Soft tissue laceration
    Repair, ligation, reduction of fracture and Postnasal pack

Cervical spine injury
Can be deadly if it involved the odontoid process of the axis bone of the axis vertebra
If the injury above the clavicle bone, clavicle collar should minimize the risk of any deterioration

Emergency treatment in case of chest injury
Occluding of open chest wounds
Endotreacheal intubation for unstable flail chest
Intermittent positive pressure ventilation
Needle decompression of the pericardium
Decompression of gastric dilation and aspiration of stomach content

Circulatory collapse leads to low blood pressure, increasing pulse rate and diminished capillary filling at the periphery
Patient resuscitation - Restoration of cardio-respiratory function
Shock management - Replacement of lost fluid...

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