CRITICAL CARE FOUNDATION POLYTRAUMA

Transcription

1 CRITICAL CARE FOUNDATION Rungta Hospital, Malviya Nagar, Jaipur (Supported by Indian Society of Critical Care Medicine, Jaipur Chapter) MODULE 2 POLYTRAUMA Note : All rights reserved. No part of this module may be reproduced in any manner, print photocopy or electronic without the permission of the Foundation.

2 The Theme of Training : The Critical Care Medicine meant for the care of Polytrauma (Pre-requisites, primary, secondary and tertiary care and tranportation of patient of Polytrauma to Higher Centre). (A) Outline : DURATION 12 HRS. OVER 2 DAYS (Interspaced with tea and lunch breaks) 7 hours will be for theory lectures over Power-point over different topics. 3 hours for Skill Stations with actual hands on training. 1 hour ICU round where they will be exposed to ICU infrastructure, staff, disciplinary protocols and working. 1 hour for evaluation in form of Test consisting of 50 questions with options of MCQ s. They will be expected to answer 60% of the total questions. PARTICIPANTS : Each time at about doctors should be registered (B) Module Objectives : Prioritize assessment needs for the patients of Polytrauma. Identify appropriate diagnostic tests for the patients of Polytrauma. Identify and respond to significant changes in the unstable patient. Be able to recognize and initiate management of acute life threatening conditions. Recognize the need for patient transfer and prepare the practitioner for optimally accomplishing that purpose.

3 Session wise Chapter - each Chapter will have : B-1 Specific Objective for the session B-2 Introduction to the topic B-3 Technical Contents Referred to our Polytrauma Book including complete information in its spiral binding form. B-4 Methodology for its teaching Powerpoint Presentation, LCD display (Theory part) & Dummies and live demonstration of Polytrauma (if available) in ICU (Skill station and Round of ICU part) B-5 Evaluation of the Session A session of 40 minutes for the evaluation of the candidate who will participate in our two days programme which have 50 Multiple Choice Questions. Atleast 60% marks will be necessary to consider a candidate to be Qualified (C) Suggested Reading Material : Each Chapter as mentioned in our Polytrauma Book will be followed by suggested readings, references pertaining to the selected topics. (D) Topics (Theory Part) : 1 How do we care for the Multiple Injured Patient 2 Objectives 3 Trauma Score 4 Trauma Management : Golden Hour 5 Principles of Trauma Management 6 Triage 7 Indications for ICU admission 8 Primary Survey 9 Secondary Survey 10 Definitive Care Skill Stations : 1. Airway 2. Central Lines 3. CPR 4. Defibrillation 5. Transport of Polytrauma Patient ROUND OF ICU (LIVE DEMOSTRATION) : As mentioned

4 Index S.No. TOPIC 1. Initial Assessment & Management of Poly- Trauma Patients Page No Initial Resuscitation of the Injured Patient Airway Shock Thoracic Injury Abdominal Injuries Head Injury Spinal Cord Injury Extremity Injury Paediatric Injury Damage Control The Abdominal Compartment Syndrome (ACS) 37-40

5 PROGRAMME DURATION - 3 Days TRANIEES - NOT MORE THAN 30 SESSIONS /DURATIONS DURATION Topic DAY 1 90 minutes Initial Assessment & Management of Poly-trauma Patients 90 minutes Initial Resuscitation of the Injured Patient 45 minutes Airway 45 minutes Shock 90 minutes Thoracic Injury DAY 2 90 minutes Abnormal Injuries 90 minutes Head Injury 45 minutes Spinal Cord Injury 45 minutes Extremity Injury 45 Minutes Paediatric Injury 45 minutes Damage Control DAY 3 90 minutes The Abdominal Compartment Syndrome (ACS) 45 minutes each SKILL STATIONS (i) Airway (ii) Central Lines (iii) CPR (iv) Defibrillation (v) Transport of Polytrauma Patient 45 minutes Hands in ICU TEACHING/TEACHINGS AIDS- LECTURES DEMONSTRATIONS HANDS ON EXPERIENCES POWER- POINT AND OHP PRESENTATIONS VIDEO/LAPTOP- CD PRESENTATIONS ICU / GENERAL WARDS

6 PRE & POST EVALUATION QUESTIONS Q. 1 Revised Trauma Score takes into consideration all the following physiologic criteria except : (a) Glasgow coma scale score (b) Respiratory rate (c) Capillary refill (d) B.P Q. 2 Trauma index encompasses all the following except : (a) Type of injury (b) Cardiovascular status (c) CNS status Q. 3 Which of the following is not a mediator of physiologic response to trauma? (a) Renin and Angiotensin (b) Sympathoadrenal axis (c) ADH Q. 4 Which of the following is not a predictor of mortality in trauma patients? (a) APACHE (b) ASCOT (c) TRICS (d) GCS Q. 5 In the primary survey of a trauma patient, absent radial and carotid pulse would indicate the following, respectively : (a) B.P <100 and B.P <80 (b) B.P <80 AND B.P <60 (c) B.P <60 AND B.P <40 Q. 6 Which of the following is not a recommended methods to open the airway : (a) Modified Jaw thrust (b) Modified chin thrust (c) Chin lift (d) Jaw thrust Q. 7 While resuscitating a trauma patient, the following is the right sequence : (a) Immobilise C-Spine, Keep airway open, oxygenate, establish iv route (b) Keep airway open, immobilize c-spine, oxygenate, establish iv route (c) Oxygenate, immobilize c-spine, keep airway open, establish iv route Q. 8 During primary survey of the management of a trauma management, consider assisted ventilations in case of all the following except : (a) 12 > Respirations > 24 (b) Tidal volume decreased (c) Respiratory effort decreased Q. 9 Which variable is not included in Trauma index : (a) Region of body injured (b) Cardiovascular status (c) CNS status (d) Urine Output Q. 10 Revised Trauma Score (RTS) is based on : (a) Glasgow coma scale score (b) Respiratory rate (c) Systemic BP (d) All of the above Q. 11 Which is not true for the Opening the airways : (a) Modified jaw thrust (b) Chin lift (c) Jaw lift (d) Endotracheal intubation Q. 12 Consider assisted ventilation except : (a) Respirations rate < 12 (b) Respirations rate > 24 (c) Tidal volume decreased Q. 13 What are the sign of impaired perfusion except : (a) Capillary refill < 2 sec. (b) Restlessness (c) Anxiety (d) Capillary refill > 2 sec.

7 Q. 14 During secondary survey of Abdominal Evaluation, which is not allowed : (a) Bleep the trauma team (b) Chin lift, head tilt (c) Large bore needles (d) Jaw thrust Q. 15 Shock is classified as Class III except : (a) % Blood Loss 40% (b) Volume Blood Loss (70 kg) 2000 ml (c) % Blood Loss >40% (d) Tachycardia Q. 16 Regarding Glasgow Coma Scale, which is not true : Score GCS (a) (b) (c) (d) 0 3 Q. 17 Injury which can cause death within minutes, except : (a) Airway obstruction (b) Tension pneumothorax (c) Aortic rupture (d) Pericardial temponade Q. 18 Regarding Crush syndrome, which is not true : (a) Rhabdomyolosis (b) Myoglobinuria (c) Alkalosis (d) DIC Q. 19. Regarding Abdominal Compartment Syndrome (ACS), which is not true? (a) Increase IAP (>20mm Hg) (b) Increase PaCO2 (>45 mm Hg) (c) Decrease in Tidal volume (d) Decrease Airway pressure Q. 20 Indication for performing PAG include: (a) abdominal decompression (b) inability to close abdomen (c) Re-exploration of abdominal sepsis (d) All of the above ANSWER KEY Q. 1 c Q. 2 d Q. 3 d Q. 4 c Q. 5 b Q. 6 b Q. 7 a Q. 8 c Q. 9. c Q.10. d Q. 11 d Q. 12 d Q. 13 a Q. 14 b Q. 15 c Q. 16 c Q. 17 c Q. 18 c Q. 19 d Q. 20 d