Best management of RTA in periphery for reaching District hospital

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Accident and Trauma care is a challenging field. Most of the peripheral hospital have 24 hr accident and Trauma care. Usually the cases are not life or limb threatening. Once in a while serious cases and even poly trauma land up. Usually there are doctors on call in such situations. But a Casualty Medical officer should be proficient in stabilizing the patient till help arrives or refer the patient after stabilizing. There are elaborate protocols available. I will explain some practical points. First of all Airway Breathing and Circulation in that order. Basic life support protocol. From orthopaedic point of view: Harmodynamic stabilization is a priority. Iv access on arrival Get more than one with large bore cannula In case of shock with collapsed veins, a venous cut down above elbow may be needed. Crystalloids like NS or RL can be pumped very fast. Colloids like Haemaccel to keep fluid in vascular compartment Venous cut downs help in monitoring Central venous pressure to assess volume replacement Foley's catheter to monitor urine output. Few clinical examination tips Check pupils for inequality Check cervical spine: If the patient is conscious, ask him to rotate his neck left and right. If not able to do freely, apply cervical collar. Do not use passive movements in spine. Gently compress rib cage to rule out chest injury. Palpate the abdomen for guarding and rigidity Use pelvic compression and pubic symphysis pressure to assess pelvic injury Check limbs for deformity: can gently move. Check distal pulses Splint the fractures Commercially available moulded splints can be used Thomas splint is especially useful in lower limb fractures. A fracture femur can cause internal bleed of one and half litres of blood A fracture pelvis can cause two litres of internal bleed Checking dorsal and lumbar spine is difficult in lying position Gently tilt the body, put the hand behind and palpate for swelling and tenderness. To save lives in critical situations, you need many people doing all these at the same time. Teaching the Nursing and Paramedical staff is important Be very careful While moving spine and Pelvic injuries, even after stabilizing. There specific protocols for spine. In unstable pelvic fracture, movements can cause disastrous arterial bleeding by dislodging of thrombus. For more information read books on Trauma care. These are only tips:Not a protocol.

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