Trauma Assessment - Multiple Injuries (Part 2)

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This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury. This video is part 2 of a muti-system injury scenario (airway compromise, tension pneumothorax, bleeding and head injury).
All videos on this channel are linked to Oxford Medical Education (www.oxfordmedicaleducation.com)
This video was produced in collaboration with Oxford Medical Illustration - a department of Oxford University Hospitals NHS Trust. For more information, please visit www.oxfordmi.nhs.uk

Опубликовано:

11 окт 2024

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Комментарии : 23

@maternenshutikayumba4685 2 месяца назад

I would add: DRE for high riding prostate, check urethra meatus, check pelvic mobility, and spine tenderness. Excellent job.

@OxfordMedicalVideos 11 лет назад

Thanks for your comment - a fair point. This video is really just to demonstrate the systematic approach to trauma management but yes, as the patient is unlikely to be able to protect his airway with a GCS < 8, intubation would be indicated.

@OxfordMedicalVideos 11 лет назад

As you say, this is a training video so just runs through the basic steps. You're absolutely right though, permissive hypotension is now widely practised and ATLS 8e reflects this. There is reasonable evidence to suggest that - in trauma - fluid resuscitation to maintain a palpable radial pulse (systolic 80-90mm Hg) is optimal as it decreases ongoing haemorrhage by allowing clot stabilisation. Giving blood followed by definitive surgical management is ideal. Good point though, thank you.

@leannejackson9026 9 лет назад

This is a brilliant video and although i am a Student Nurse doing an OSCE soon, it is still very useful. It is a shame that there isn't any of these specifically for Student Nurse OSCE's. Thank you

@luisgonzalez9043 Год назад

She is having so much fun isn’t she?

@fastmango 11 лет назад

Good video for medical student OSCEs. One thing though, surely with a palpable radial pulse and BP 110/70, you practice permissive hypotension and don't give fluids. If he does need fluids it should then be blood

@warrenmaya7934 8 лет назад

Great video, thanks for posting. Just an observation: I didn't see him actually palpating/compressing/assessing the pelvis. If the patient has an unstable pelvic fracture, he/she would need a pelvic binder. By the time the pelvic x-rays is reviewed, the patient may have lost a great volume of blood. I'm not sure if I missed that part.

@OxfordMedicalVideos 8 лет назад

+Warren Maya Good point, thanks. There should always be a very low threshold for binding the pelvis and getting imaging if any suspicion of fracture (e.g. pain or mechanism of injury). Palpating, compressing or 'springing' the pelvis should not be done as it is a poor sign may worsen haemorrhage... www.trauma.org/archive/ortho/clinicalexam.html

@andrii0905 10 лет назад

A very good way of teaching! Although I was wondering why there was no examination or assessment of the spine/vertebrae, though you did stabilize the c-spine. Why no radiological assessment?

@OxfordMedicalVideos 10 лет назад

Thanks for your comment. In this case we are running through a trauma scenario primary survey only. The c-spine is therefore stabilised empirically to ensure efficient speed through this section. Full clinical c-spine assessment would come later in the secondary survey, with radiological assessment based on that.

@louisdebernard9332 4 года назад

Patient should really have a full body CT scan as they are stable haemodynamically and have clinical signs of head and cardiothoracic injury, preferably after an RSI to protect the airway and to provide secondary neuroprotection. Plain C-spine X-ray is not sensitive enough to rule out C-spine injury in patients whom are unable to response adequately for clinical assessment of their cervical spine. This patient has a high risk of C-spine injury due to their comorbid head injury so a CT scan is warranted. pubmed.ncbi.nlm.nih.gov/15920400/ www.ncbi.nlm.nih.gov/pmc/articles/PMC3177586/

@carlosriquelme841 4 года назад

Very Nicke training, thanks!

@bokasahamad8151 5 лет назад

Very nice What about the urine catheter?

@juicystories7006 2 года назад

Good job,

@N305UK3 11 лет назад

Interesting video, thanks for posting it. I have a question though. It seems like his Glasgow score was < 8 on D avaliation, wouldn't that be an indication for immediate intubation?

@lucijakarija8928 3 года назад

He was intubated in the first part

@azizmarouani7691 Год назад

Better to intubate the pt with univent bronchial blocker if GCS below 8 to preserve the airway especially pt has tension pneumothorax

@luciasoliman2946 3 месяца назад

Glucose of 5 is what in America 5 is an emergency and high priority

@endliberalism382 7 лет назад

is this training for paramedics or nurses?

@kyleocallaghan9185 5 лет назад

It's a medical student, ie training to a be a Dr, but from a paramedic perspective prehospitally we still perform the same assessment and carry out a similar level of patient management depending on skill level.

@FrankEdavidson Год назад

OCSE for Emergency Medicine blokc of MBChB / MBBS. Perhaps might be repeated for postgrads as it never hurts to go through basic algorithms. I might be wrong but or pre-hospital care even if trauma / ED surgeon, anaesthetist is on scene definitive airway i.e. Intubation might not be possible due to lack of monitoring, surgical backup, sterile field? Pt would probably arrive immobilised by ambulance personnel.

@bobjohns2118 11 лет назад

FAST in ED job not surgeons.

@FrankEdavidson Год назад

FAST is also available in prehospital care in some areas depending on how equipped the ambulance service and field medical / voluntary network organisations e.g. BASICS (UK), United Hatzalah (IL) are and local policies. I've seen FAST demonstrated by Professor James Ferguson, EM consultant for use in prehospital care by Scottish Ambulance Service and/or BASICS.