Lucky to be alive in India, Be ware, You can be crushed mentally or physically!

Crush is defined as below in Dictionary.com,

crush

   [kruhsh]  Show IPA

verb (used with object)

1.

to press or squeeze with a force that destroys or deforms.

2.

to squeeze or pound into small fragments or particles, asore, stone, etc.

3.

to force out by pressing or squeezing; extract: to crushcottonseeds in order to produce oil.

4.

to rumple; wrinkle; crease.

5.

to smooth or flatten by pressure: to crush leather.

Crush i Have not known to be defined by crushed to Death or mashed with severe injuries. 

However when you start practising in India as an Ortho Surgeon, you cannot miss this definition. I have now seen people crushed with severe injuries and the most upsetting one is when the crush is due to Run over by big vehicles such as lorry.

Here i would like to ask you to watch the two wheel vehicles driven  by the family head with his family of two or three or even four travelling in this vehicle. you would say is there anything in particular you want to add to what we kn0w as a common occurance.

Watch carefully, then you would realize the wife/mother of the family at the back simply sits without holding onto anything as she often uses both hands to hold the child in her lap or even worse, she holds on the shopping bag.

Now you start wondering how the hell does she keep a balance on this vehicle with a narrow seat with the two wheeler speeding with the potholes and speed breakers. I suppose just like our cochlea, the whole body is kept under equilibrium and she is safe.

Then you read this scenario where a pregnant wife of 7 months in the pillion seat of the two wheeler falls off on the wrong side of the road due to the collision by another two wheeler. You are going to ask me if the child is safe as the lady is pregnant. 

What i am going to write now may upset you, but please read on!

But the pregnant lady having fallen onto the road, was then run over by the lorry to death. 

the unborn child you have to remember would not have died straight away like the mother who was run over her head. 

The Child would have died few minutes later as the heart of the mother would have kept the child alive even thou for only further few minutes.

Now this really begs the question, what are our priorities in India right now!

Educate ourselves and others on this issue of Road safety. people dying of diseases, infections, even cancer have some time to reconcile themselves and the relatives have time to get accustomed to the idea of losing someone they love.

But Road Traffic Accident Victims, they are knocked into a wilderness without even having a second of warning

What is more upsetting is unlike the diseases, this illness due to the Road traffic accidents are still believed to be accidents. I feel that they are incidents.

For an incident to happen, there must be a hazard and a risk, and we should be able to predict that this would happen!

Now in this scenario, mothers sitting to one side of a two wheeler with no grip or hold are definitely going to be falling, thus the risk is very high. The hazards as we have discussed are the unruly drivers who are on your way.

When i mentioned that one must be unlucky to have been injured in a RTA in India, my friend says that one should be lucky to be alive in India

Drive Safely

But more important, look after your family

Warm Regards

Chockalingam

Initial Assessment and Management in Trauma a short overview for doctors in general and intersted public.. Donate your blood and Do it Now

I have given some of the content in Red useful for general public and if you are not a doctor and do not want to know all these, at least go to the end of the blog and read the sentence in red and see if you can do it!

Initial Assessment and Management

Roadside

Think of the following scenarios in RTA as you may be a doctor or a general public nearby!

12 year old girl with headache and arm pain

65 year old grandfather with bilateral shoulder and arm pain

38 year old mother screaming in agony

45 year old father dead on arrival to a local hospital

A Middle aged man

History of RTA

Brought with

Pulse 90/mt

BP 140/90mm Hg

RR 25/mt

The sixteen year old

RTA in Vayalur Road

Rings his parents at 5 PM

Taken to few hospitals before

Brought to Kauvery

Not very alert

Initial management of Trauma is different

to what we learn in our Medical Schools where we are taught to take a detailed history, do examination and investigate and then come to a diagnosis before treating a patient

Why

Multiple casualties

Do not want to miss Important injuries

Do not want to miss important injury until it is too late

Do know how to be safe to yourself

It is OK to Call for Help

Standard Precautions

Cap

Gown

Gloves

Mask

Shoe covers

Goggles/face shields

The following is a synopsis of what you do in an emergency of trauma

The quick ten second assessment for anyone to follow on the roadside and at initial contact

I am "   " and

What is your name

Tell me what happened

If you get answers to the two questions, we can relax a bit as the airway is ok at present and not in severe shock or head injury

Airway and Cervical Spine

worry about the airway if

Patient is not talking

Noisy breathing

Secretions, FB, Loose tooth

The Chest is not moving

Get the airway sorted out first by

Establishing A Patent Airway 

or

Securing a Patent Airway

                                         
And How?

Establish a patent Airway by Clearing of Secretions and blood, ensure that theTongue not falling back by pulling the chin forward but do not bend the neck backwards, and the safer method would be to do jaw thrust

Use Airway Adjuncts

Give Oxygen

Adjuncts

B for

And the

Muscles and nerves to control

How to assess by looking for the

Symmetry of chest movement

Respiratory rate

Tracheal position

Percuss and auscultate

Manage B:what do you do

If chest is not moving at all?

If Chest is moving unequally?

If Hyperresonant or dull to percuss and no air entry to one side?

C for

Heart

Major Vessels

Organs: Brain, Heart, Kidney, skin

How to assess

Heart Rate

Blood Pressure

Skin: Colour, Sweating

Conscious level

Urine Output

Manage C

Restore Volume and Control Hemorrhage

IV Access

Fluids

Blood

Put it all together

A-----------------------------With ----Cervical spine protection

B------------------------------

C------------------------------

Reassess

Be ware in Children, pregnant women and Elderly

Be ware of Pulse oximetry reading BP

D

Disability

D for

Neurological Evaluation

GCS

Pupils

Localizing Neurological Signs

Serially Assess for deterioration

E for  Exposure / Environment

Watch for Hypothermia


Get the history as below

A Allergies

M Medications

P Past Medical/Surgical History/Pregnancy

L Last meal

E Events/Environment related to injury

Detailed assessment

History

Complete head-to-toe examination

“Tubes and Fingers in every orifice”

Complete Neuro exam

Special diagnostic tests

Reevaluation

Head To Toe Examination

Head

Neck

Chest

Abdomen and Pelvis and Perineum

Extremities

Spine and Neurological examination

Communicate with patient and others

Pain management

Maintain Records

Before transfer

To X ray

To CT scan

To theatre

To ICU/Ward

Summary

Quick Assessment and primary survey, use adjuncts

Treat to correct the problem as you find

Complete detailed assessment

Hope you found the above synopsis useful

Remember there are two life saving drugs in trauma, one is oxygen and the other is blood and both are available or should be made available widely. Oxygen is outside 

but

Donate your blood and Do it today

Thank You

Warm Regards, Chockalingam