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HEAD INJURY

Deterioration

    - Unequal or dilated pupils may indicate increased intracranial pressure
    - Avoid sedation or analgesics as it interferes with neurologic examinations, reduces breathing (increased CO2 causes increased intracranial pressure)
    - Bradycardia, hypertension may indicate worsening condition

 

EXPOSURE

  • Remove all patient's clothing
  • Examine whole patient
  • Front and back; log roll carefully
  • Do not allow patient to get cold (especially children)

IMAGING

X-Rays

    - Chest
    - Pelvis
    - Cervical spine

Ultrasound

    - FAST scan

PHASE III: SECONDARY SURVEY

Head Exam
    - Scalp, eyes, ears
    - Soft tissues
Chest Exam
    - Clavicles, ribs
    - Breath, heart sounds
Neck Exam
    - Penetrating injuries
    - Swelling or crepitus
Abdominal Exam
    - Penetrating injury
    - Blunt injury: nasogastric tube
    - Rectal exam
    - Urinary catheter
Neurological Exam
    - Glasgow Coma Score
    - Motor examination
  • Sensory examination
  • Reflexes
Pelvis and Limbs
    - Fractures
    - Pulses
    - Lacerations, ecchymosis

URINARY CATHETER PLACEMENT

Module1_21
  • Wash area with soap and water, retract prepuce
  • Put on sterile gloves, apply bland antiseptic
  • Check integrity of catheter balloon
  • Lubricate catheter generously
  • Hold penis vertically, slightly stretched
  • Introduce catheter gently-don't force
  • Urine in catheter confirms placement
  • Inflate balloon slowly
  • Replace prepuce

REASSESSMENT

  • Always perform an ABCDE primary survey if patient deteriorates
  • Signs of adequate resuscitation
      - Slowing of tachycardia
      - Urine output normalizes
      - Blood pressure increases

MONITORING

  • EKG monitoring if available
  • Pulse oximeter
      - Most widely used physiological monitoring device for heart rate, oxygenation
      - Especially useful in anaesthesia, ICU
      - Simple to use
      - Should be minimum standard of monitoring in every surgical theatre
  • Blood pressure
      - Manually or automated machine
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