In triage of school bus accident of children, which one will you attend first and give priority?
ANS. A# Evaluation of a trauma victimPrimary survey in trauma# Focused history and physical examination (secondary survey)The focused history and physical examination includes a physical examination that focuses on a specific injury or medical complaint, or it may be a rapid examination of the entire body.It also includes obtaining a patient history and vital signs.Patient history: A patient history includes any information relating to the current complaint or condition, as well as past medical problems that could be related. Utilize bystanders/family... when needed.Acronym to obtain a patient's history:S: Signs/symptomsA: AllergiesM: MedicationsP: Pertinent past medical historyL: Last oral intakeE: Events leading to the illness or injuryRapid assessment: This a quick, less detailed head-to-toe assessment of the most critical patients.Focused assessment: This is an examination conducted on stable patients. It focuses on a specific injury or medical complaint.Vital signs: This include pulse, respirations, skin signs, pupils, and blood pressure. This may include documenting the oxygen saturation level (this is highly useful when dealing with chemical agent exposure).Pulse: Assess for rate, rhythm, and strength.Respiration: Assess for rate, depth, sound, and ease of breathing.Skin signs: Assess for color, temperature, and moisture.Pupils: Check pupils for size, equality, and reaction to light.Constricted pupils in a mass casualty event are highly suggestive of nerve agent/organophosphate toxicity.Head-to toe examination of a trauma patient with significant MOI--The physical examination of the patient should take not more than two to three minutes.Chain of survival Note: The boxes bordered with dashed lines are performed by healthcare providers and not by lay rescuers # To simplify* Treatment of unstable tachycardia: Synchronized DC version* Treatment of stable tachycardia: Drugs and carotid massage* Treatment of unstable bradycardia: Transcutaneous pacing/ medical pacing (atropine 0.5 mg (up to 3 mg) or injection adrenaline (2-20 mg/kg/min) or injection dopamine (2-20 mg/kg/min)* Treatment of stable bradycardia: Expert consultation for identifying cause.# How to say a patient is stable or not (look for CHAPS)1. Chest pain2. Hypotension <90 mm Hg3. Altered mental status4. Pulmonary signs of cardiac failure (crepitations)5. Signs of shock (cold and clammy extremities)# Important imaging questions potential to be asked from emergenciesHampton's hump (pulmonary embolism)Glasgow coma scaleObservationResponseScoreEyesOpen spontaneously4Open to speech3Open to painful stimulus2No response (no eye opening)1VerbalResponds sensibly5Confused4Inappropriate words3Incomprehensible sounds2No response (silent)1MotorObeys commands6Points (localizes) to pain5Withdraws from pain4Bend limbs in response to pain (flexion)3Straighten limbs in response to pain (extension)2No response1# Nexus criteria is used in evaluating a case of suspectedC-spine injuryNexus criteria1. Absence of tenderness in the posterior midline2. Absence of a neurological deficit3. Normal level of alertness (GCS score = 15)4. No evidence of intoxication (drugs or alcohol)5. No distracting injury/pain* Patient who fulfilled all 5 of the criteria were considered low risk for C-spine injury- No need C-spine X-ray* For patients who had any of the 5 criteria- Radiographic imaging was indicated(AP, lateral and open mouth views)# Focussed abdominal sonography in trauma (FAST)# FAST positive# e-FAST (extended FAST)Includes FAST along with lung ultrasound to detect any life-threatening emergencies like pneumothorax.# Findings in e-FASTNormal seashore pattern# Pneumothorax showing barcode sign
Airway obstruction of child
Boy in shock
Flair chest child
Severe head injury
C.V.S.