Trauma management

Apr 15th, 2015
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PRINCIPLES OF MANAGEMENT OFTRAUMA PATIENTDR. GEORGE MUGENYAMBCHB, M.MED, FCS (ECSA)Introduction Trauma usually refers to the adverse consequenceof a mechanical force on a patient. Trauma is the leading cause of death in first fourdecades of life.TRIMODAL PEAK OF DEATH 1-First peak: seconds to minutes. 2-Second peak: minutes to hours. 3-Third peak: several days to weeks from initialtrauma.Trauma Death DistributionDeaths from trauma follow a trimodal distribution:1. Immediate deaths in the first minutes at the scene due to: Massive haemorrhage Crush injuries. Massive CNS trauma. Airway obstruction.2. Early deaths during the Golden hour are often due to: The effects of haemorrhage. The effects of hypoxia.3. Late deaths are chiefly due to: Sepsis. Organ failure.'Golden Hour' The Golden Hour is defined as the time period of onehour in which the lives of a majority of criticallyinjured trauma patients can be saved if definitivesurgical intervention is provided. During this period all efforts should be made to save alife before irreversible pathological changes occur inorder to reduce or prevent death in the 2nd and 3rdphases...'Golden Hour' 'Golden Hour' concept was derived from French WorldWar-I data in 1918. Time between injury and adequate shock treatmentdetermined mortality/outcome:Time from injury1 hr2 hr3 hr4 hr5 hr6 hr8 hr10 hrMortality10 %11 %12 %33

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