SUMMARY OF DASIC ee ea Potent Boag ere hs SUGCAL & Han InFEciONS Sano ri nes SURGICAL NUTRTION cea am ae Een if you found it useful eaten oy Ee LLdeTLS Management of poly-trauma pt. "Q. should be writen in any major rauna”™ (ir way & breahine on) 1” SURVEY Iely & Tar ay Ui seeing coneton 3RY < Dtinive 1 of | ck nj inal PRE HOSPTAUZATION (ABCDE) “ATHOSETAL Gere oe es 1) Clow amy Cicer on 1 2) Head it & chi Tcluosowy, —— Wied or se head HANG Fur = as inj on MEF aa > MeMedison. Spine, map oS SSEHE EH oor wut) | fanmnct 1) Tason ewon: KEMRIRRRY crue pptcl Chest - Uni KUT (x + Ecos nick ven. «Shia wedbrinun, cfivam, | fivarm= ccs | [Ekem=ABG ) | Spine Cu Yew) + Rasp dues, Ain blow aa ys y 1) ON PREWMOT: ESORTMNORNE Cue T (Ct bees Ruscha ce ene ALS ‘ABDOMEN peopel 3) CARDIAC TAMPONADE AT 150 Mt PeRcARDIOTOMY N pr nab) Beck's mind (Eacoead NV, Iponeion, JS) | MOSTOF IS ——— 7 SX ERE plonion a -£¥E CRTERIAIN DPI 44) FLAL CHEST Pandoxica wv. > SENET (PEEP) I T > 10.40 RBC? THORNS Ov ACETAN SEEN. a cc 1s) > PNB 5) MASSE HeMors, > KS “THoacoromY * Gun shor, >ATS1U Aloe uon cles LAR ENTRY + Ussble. (soca) Major jy ov Cine. Esphin Chose 8 monageven of EONS Soli onan & || "Any holow x + hewo-pestoeus win | a Disabiliy =1ssponts 0 oc sine RR) T — AYPU Usasponinee = Exgosim 6 inser dV ; Ew. Te, fol, le.HyP0-VOLEMIC SHOCK ETIOLOGY: “inadequate tise perfusion > 1) Loss OF 81000 —> Hae. (intemal or oesnal) eae 2) PLASMA —> burns, pscentns & psitosiis 3) NA CONTAINING FLUIDS -> scvre NVD, 10, big ouput ivestnal sat CHANGES IN SHOCK. Bopy RESPONSE UHowwomuss: rane of NUK pump -> *VCof eo Radio else of Na + Pll ls ; aa Revesrsible pluses InREvERSIble) phases, ] DLNEURAL: © of Ansa anos & Arial Sach ns => He Vaca inion inl on YMC + © of sympa. sist ‘AL COMPENSATORY PHASE: VC of -CLDECOMPENSATION PHASE: . n D-cap, spine —> 4 exp. passe eae Sa eee capt hom he ial spc tpesibanserel > talation of he p-esp. FUNG: VC of 8) CELL STRESS PAHSE: sphincien only —> scum, of RBCs aaisioles > Leap. pr cap ell ow | peng ofthe AY shuns > Sis -> 1 eon ‘he inert space. > depaive ts fon O, = Avwetboic erable DDLFALURE: FINALY rhe post cap, 7 mecbolis 8 hstaine sphicen wil esx —> passage of the > cosimction of post cap spieren sludge & ptheowbi 0 he ci, 2Classification & TREATMENT Cuass | 1 a v 1) Bloopiess 15 % 50% 40%, > 40% 2) Puise/MIN—->90< 100 > 100 > 120 >140 3) BP Nowa! Norval low ow 4) RR 14-20 (vonml) 20-25 25-40 > 40 5) URINE (mi/H} 50-50 ml/h (nonmal) 20-50, 10-20 0-10 6) Mena status — alenr Axxious Aqgassive & drowsy Drowsy 10 uxconscious 7) San, Now! Pale & cold Pale & cold Pale & cold 1) RESUSCTANON —> fash bl. os FFP. RSE Less. IV CANULA —> ANALGESICS. (Momphia ins in head injury om RF on LCF) == ‘1.Bloop sami: CBC - HY full chemist MONITORING 1) ViaL DATA: (Pulse, BP, RR, Tewp. 2) CVP > iy ? dr Yoluse OL 08 HE 3) CATHETER-> LOP N= 50-50 wl.) 4) PAWP (Puiu. Arseny Weds Pa.) tnesuned by Suan-Gane eahees. 5) He %- ECG. 6) ABG. (PO, & PCO,) Dobut of ETT + Mech. Dat ge PETES Mich ve + Dic vee #0, wsSeptic "ENDOTOXIC" SHOCK = CA wosily G -ve E. colt = Sup. — Candid ‘= PDF -> Pavoni, Cholangitis, Stanculsion, Preunoni CY cutee, ARDS — erect IN + Veniion di Shock & loss of sua + Difision di eesti PEL + Peafsion dr solar ssi. + On SET + TTT ETT + she cuse + ¥ Suppons! ~ *SIRS* => VD + ‘opening oF AN shuns 1 Vascular endo dang 1M, Acidosis. « MOE. = DIC dr @ of PAF + slugcsh cincubnion, ARDS. Asche iy te isin cos bavi > Bacieial Tsnlocaion u G -VE ENDOTOXEMIA Tp. > 38 & chills + BP sighnly b+ #7 HR, RR & UOP + TOP (bur 4 PR > bung pulse) 2 Yom cms, ‘AS ATE HYPOVOL, SHOCK Tonp: 98.02 < 36 * HR > 90), “= RR > 20s. {© WBC 12 oF < 4,000 as + Cold ex Pe 1) BP & CBC —> Irvcocyosis ‘om ltcopenin. (rv Ie tages)COMPLICATIONS OF BL. TRANSFUSION Prosuem Cause cp ™ EARLY Fes ‘Minor bacterial FAHMR, NV. 1) Stor mANstUSON, REACTIONS (M/C) | contamination. 2) IV ANTHHISTAMNICS & hydrocortisone ALLERGIC ‘Allergens in the ranging from mild itching & urticoril ‘As cbove REACTIONS donor blood up fo laryngeal edema & shock EARUEST-> PAN AT ITE OF TRANSFUSION. 1] Stor ne mansrusoee + Fever, Rigors, NV. : Rigors, 2) SHOCK IV crystlloids & Steroids Hewouynic + Chest pain, dyspnea & cyanosis d yale & Seid REACTIONS | ABO incompatiiliy. | + Hypotension & Tachycardia, 3) MontToR UOP by Fouer's cATHErER, wp) +l comarosto-» Bl tendency. 4) MaxiTOL oR AUK. OF URN by NaHCO, «+ Ir sever > Joundice, DIC, ARFR hemoglobinuria, poin in flanks! Cras AIR EMBOLISM 2) MILL:WHEEL murmur over the heort, | 2) PLACETHET. ON HS toe with head down. 3) ASPIRATION oF TH RV. THROMBOPHLEBITIS in the recpien vein. . 1) PaciED RBCS. (btter) CHE erly with sc Massive a 2} 0, MAS, ASK IV, DAL. Blood sone | HYPERKALEMIA | dt destroyed RBCs GLUCOSEINSULN INFUSION. $000 mt | HYPO-THERMIA | Prolonged storage of bl. | Arrhythmia up to arrest ‘SPECIAL WARMING UNI. ‘over 24 Ins | CITRATE TOXICITY | Binds to Ca. Acidosis & arest TOL OF 10% Ca cuuconarE. COAG. FAILURE | | factors V & Vil EaRUest > tingling & crcum-orl mumbress | 1 yy oy FFP + PLATELETS / UNT STORED BOOK -ms bitches & etary.©) Lie ~ blood bone infections —> avoided by —> scecening, CEES TY aoubo-plebis, = ypovolenc shock. (i mse) = Vso aac NB ‘CoMPuCATIONS OF DONOS Pe COAGULATION DEFECTS INTRINSIC PATHWAY EXTRINSIC PATHWAY Pam, 106 by cowracr of blood with collagen | NEéds ss fcr (damage) of danced ws. 08 table /giss > F, (Tissue shnomboplsiy now sub«ndor) 2) Fucsor 12> 11> 9 > B > combines wit (F2)(paorcomvein) (jssi-hawopie abuts) TF, complex > + Fy + iv paesence of Ca & phonphliis Fouow uP Pr PI on INR (0.8-2-3) auc maar (-) ‘HEPARIN & ClExAN (LMWH): Wagan *SEE VASOUAR™ “SEE VASCULAR Bik PTT & PT ae sows ples on vsculen fe, Bork is esse of common pasluay defer HEMOPHILIA WF DISEASE MIC inherited Cloning defect, * MIC inherived bl. disorder. (AD) + 2° MIC bleeding donde. + Fond by a gaat pls &esdorh. Cal, # Acheron 8 def. B= fc1on 9 (Chass fcion) | * + Nowwal PI & B — Prolongtd PIT & CT. 5 FEP docs’ ic Helps in > plucler ag & cain for F. m7: 1) MUD > Vasopaessv or Deswoparssn. 2), SEvER -> pasa puri facioe 8 on Cayo PPTL (conniving mone fibuinogen & fcror 8)Investigations for Bleeding Tendency by exclsiont Thoubdo-cyropenia |_| Thaoxbo-sshenia spite markers of | “F< 150,000) (PF) wo (fer + PIs itis eae of 8) tcr (N= 5100) Freon 8 91112 Ixpaaiy Monioning (10- $ -2-1/13) ‘Throwbin Tive = 1 (fibinorg 1 bin) To exclude Facon 1 & 15SURGICAL INFECTIONS 5 cardinal symprons of inflammation Types, COMPLICATIONS, CLASSICALTTT Dillse Localized Specie ALocAl.-> Clwovicn, infections infections infections ‘spaead 10 neanby aneas. 21.B1000 -> Seis, Pye oxen, seuss & -EPsLAs) (nsciss, BOM & Tetanus & BL Lwveniancs > bps Cusine fe Sle 4 4 + steer stare ‘CLostaiDia: INGSION & DRANAGE EXCEPTINABC — eppipeye (orb, Bri, Cold ince) > Asp. | RIRDEMENT? (produces concalst) * Give bull, anobic. * Motil, Now-capsulcd ‘except Cl. Wile + Dru stick sponefosning. Re = BRAGS. Iiopaibic cancaene of the SCROTUM. 1+ MIC ong, iv abd. Abscess => E, COU Seo roam’ © BACTERODS -> onopliuyr, colo, agin (Nor iN unary rect) © Caw occur in ay peso, helihy 08 IC. ‘+ TTT Deweoewent of he scnorm + Gaal on fp.CELLULITIS ERYSIPELAS ABSCESS (CARBUNCLE Der Ditse SC Diffie ibonsios of EE Loca spp laneion ‘cut ifcsiow of he SC tse ifbnsion | hype (eal spends ote dsp 5) ET10, | Pench sep. —— STAB, (conse +) a ROI (hom Ovni / Ne by ood / aoe) C/P | FAHMs ScARONAL | FAHM s § CARONAL BEFORE Su.» AS CRUMUS. ‘SE: NAPE o Neck (M/C Heine ee + Active wal ele AFTER SUPRATION | (08 DoRSUM OF HAND, Lis, CHEEKS! © WN +, den : 1) Tibbs eee 2) Iwai are Genera. GEREN woe 3) Eda in oj + NB: Esp acs he msde | 3) ytycutioatann(5P +28) | LOCAL» aif dusk ui of ah an, ie clita dows Meee te (osc ise | ‘indie hes sis Liss 1) Central sone = Coup, necrosis followed by hguificrive —> Mubrple pastules appean sede of probing + Ope with wipe sases 2) Irn sn Pp mem ee = + Dsclnagng pus run ra prt rei rat of > Cadi pcan! ‘Comp, | Scheme + Rlaumnic | Schewe + Rlewwic liven on GN | 3) eit ous Ain es tos on GN {CST fer se cl , TTT) RARER TE «hos fms Boa spp > sels TGC ABS aca C&S + hot fonews INCISION & DRAINAGE UNDER GA "Nor LA duc 10 infection + opens new ples helping in spread INCISION x DRAINAGE Cinonic anscess~» EXCISION. Wale Indications of ABC abcess p+ Hs Wh 1) tong diene icon 2) Neve ests he shi esse 5) Pall 0s, & seme 4 Hiions eho ins nec, ail, poi, bess 5) Break he sp by ing. 6) PO desing Paromp BREAST PERIANAL Longindinal, chi incision, Radial on cincuw-anclas incision Lithorowy pos. Open these transversely > inode dese suscep > opentvans.—> win ser apene, bbe dain sisted sem-pened! cova he most ven an Finger to breok eset, © Counerinesonisomustina non dependable area + Crucin icision Fingers teak Prana >it ape