polytrauma management

1. Management of
polytrauma
patients at
POF Hospital
Dr.Monsif Iqbal
PGT SU-II

2. Summary Case Presentation
• Miss XYZ,a young lady 0f 23
• RTA blunt trauma abdomen
• Patient received in A & E
• Patient then shifted to ITC

3. Primary Survey Case
presentation
• Pulse….122
• BP……..80/55
• GCS……15/15
• Irritable
• pallor
• Cold & Clammy
• Grade 3 shock

4. FAST Case Presentation
FAST
performed
Frank blood Shattered
in abdominal Spleen
cavity

5. Management
Resuscitation
Exploratory Laparotomy

6. Resuscitation Case Presentation
• I/V cannulae
• Blood grouping & cross match
• Restoration of intra vascular
volume
• catheterization
• antibiotic
• Blood transfusion

7. Cont. Case Presentation
Patient rushed to OT
collapsed on OT table
Successful CPR done
blood transfusion
Patient reverted
back

8. management
EXPLORATORY
LAPAROTOMY

9. Findings of exploratory laparotomy Case Presentation
• Splenic injury ….grade 5
• Renal injury…….grade 4
• Lt colon crushed
• Abdominal cavity full of
blood
• Retroperitoneal
hematoma

10. Definitive surgical treatment
Findings of exploratory laparotomy Case Presentation
• Splenetomy
• Nephrectomy Lt
• Sigmoid
Colostomy

11. Post op recovery management
• Mechanicl vent for 2 days
• Drain output gradually reduced
• Pneumovac given
• Patient went into DIC with deranged
PT & APTT
• FFPs and platelets transfused
• 7 blood transfusions done gradually
• Stoma started working on 2nd POD

12. Cont….. management
• Patient gradually reovered
• Urine output remained satistory
• Wound….healthy
• Stitches out on 11th POD
• Patient discharged home on 13th POD

13. Diagnosis
Management of polytrauma
patients
Resuscitation
&
definitive management

14. Componenets ATLS
• Primary survey
• Resuscitation
• Secondary survey
• Definitive
management

15. Primary survey ATLS
• A..airway & cervical spine care
• B…Breathing & ventilation
• C…circulation & hemorrhage control
• D…Deformity & disability
• E…exposure & environmental cond

16. Adjuncts to primary survey ATLS
• ECG
• Urinary & Gastric catheters
• ABGs
• Pulse oximetry
• X-rays & Diagnostic studies

17. Secondary survey ATLS
• History • Examination
 Blunt ?  Head & neck
 Penetrating ?  Chest
 Burn or cold  Abdomen
injuries  Extremities
 spine

18. Adjuncts to secondary survey ATLS
• Detailed X-rays
• CT scan
• Angiography
• USG
• Transportation

19. Abdominal trauma

20. Blunt Abdominal trauma

21. Penetrating Abdominal
trauma

23. Laparotomy

24. Focused Assessment with Sonography
in Trauma FAST
• FAST examines
four areas for
free fluid:
– Morrison’s Pouch
– Perisplenic
– Pelvis
– +/-Pericardium

25. Morrison’s pouch

26. How good is FAST? FAST
• As a decision making tool for identifying
the need for laparotomy in hypotensive
patients (Systolic BP < 90), FAST has:
• a sensitivity of 92%,
• specificity of 96%
• Accuracy 93%
• How good is FAST?

27. DPL

28. Specific injuries Polytrauma
• Spleen
• Kidney
• Liver
• Intestine
• Diaphragm
• Pancreas

29. Spleen

32. Liver

33. Liver injuries management
• Push
• Plug
• Pack
• pringle

34. Kidney

35. Grades
of renal
injury

36. Pancreas

37. Intestine

41. Damage control surgery

42. Colon

44. Diaphragmatic injury

45. Statistics of trauma in
POF HOspital from
jan 2010- jan2011

46. statistics polytrauma
• Head injury….212
• Blunt abdominal injury….67
• Penetrating abdominal injury….17
• Thoracic injury……27
• Orthopedic inj…..89
• Polytrauma …..56
• Mortality…..24

47. ortho

48. Managementof Abdominal
trauma
Blunt abdominal trauma
Conservative Operative
management management
33
34

49. FAST done…. polytrauma
• Total…..57
• Positive……30
• Inconclusive…..11
• Negative……16

51. Head injury

52. Mortality

53. Take home message
‘Multidisciplinary approach required
for management of polytrauma
patient involving general
surgeon,urlogist,orthpedic
surgeon,anesthetist,radiologist etc’