ATLS 1 | Golden hour,Team,Steps,Airway

0:00 About the advance from my life ford which is not further atlas in German surgery, we will discuss it with you after cross wire, a 30 years old taxi driver comes in emergency, he is bleeding on his left hand because of that and but he is conscious, so what will you do now, what will be your first step, how will you manage and how will you do the final treatment, similarly see a 17 years old young man who is in emergency after a traffic accident and he has an injury on his left arm, now when you examined the whole body, he had multiple respirations where on the forearm and there was a lot of swelling on his hands and fingers and there is

0:46 laceration, so you have to see in which mud etc. was stuck on it and there was also black list colour, so now how will you manage it, similarly see a 15 years old motorcyclist comes near the step with a road accident and he is brought to the emergency department, he has multiple injuries, he is not even able to breathe etc., taken heart There was an attack and there is potential as well. Now how will you manage it? Similarly, there has been a suicide bomb blast in which 50 people have died and there are 150 people. Then they were brought to the hospital quickly. You have been given duty as a medical officer in the emergency ward. So what will you do? Obviously, you will know that you will do something

1:32 with them. Otherwise, the rest of the injured will also die. So everything depends on you. It depends on you. A 54-year-old working woman has handwriting problems and writing is in an impossible region. There was a lot of bleeding. Now when the accident victim is admitted to the emergency department, after 30 minutes, she was having difficulty breathing. She had no pulse. Now you have registered her but still she did not recover. So now you are saying that if you had done something with her before bringing her to the hospital, if you had done some management, then she would not have reached this condition. And if his life is saved, then this is an ideal way of saving your life, which depends on you whether you want to kill him

2:18 or what you want to do with him, because obviously if you save one life, many lives will be saved, so this chapter is very important because in this you will learn that you have saved his life here, in the golden age, in the first hour when the patient comes to you and this date is very important, I will tell you about the important thing in this, in advance payment at a relief spot, first of all you should know what is trauma, what happens in trauma is that any environmental energy is transferred in any form, which is more than the resistance of the body, that the body cannot bear it,

3:05 it is such a high force, so much environmental energy is transferred that it exceeds the resistance of the body and obviously when the energy is high, the body cannot face it, it cannot resist. It can't tolerate it, what will happen as a result of that will be cell death and cell disintegration, so this is called trauma is defined as cellular disintegration with super edited cell death due to the environment due to which cell death happens, see what used to happen in the old times, a lot of people used to

3:53 die due to trauma, why did it happen, their bleeding did not stop and bleeding did not stop and due to not stopping the bleeding, there was blood loss in their whole body, they used to go to a lot of immiya and they used to die, so the thing is that we can prevent this, but we did not prevent it, we should focus on such things which can be prevented and live can be saved, so for this reason they started focusing, they should detect the trauma forces, there should be minimum blood loss, tissue should be perfused and restored, the status of the trauma should be established, so because of this, the American College of Surgery They met and they

4:38 made drama centers and because of these, the death rate of people has reduced nowadays. In 1976, there was an orthopedic surgeon in the name of live sport. What happened was that he was flying an aircraft before that. What happened was that his plane crashed and so many people died on the spot. I mean, his wife died. I mean, this person was actually a pilot earlier. So what happened was that his wife died and three of his children died. Of these, four children sat down. One child survived. So, the child who survived

5:25 also got an arms injury in his bone. So, he thought that if I had done something earlier, my wife and children would not have died. Then he reduced it a little. Then he made a protocol for all this, which is 18. Then this was his story, because of which, I mean, he thought that the people in my life are gone, so can I save the lives of other people? Save the patient so that what happened to me does not happen to anyone else. Okay, in 1976 and then advanced drama live sport which pastes on it that appropriate, so there should be timely care, what is the concept of golden over, which updates, timely

6:11 periods, interventions are necessary to preventissibility and then this term employs morbiti and mortality, meaning mode patiri, meaning that if his bone is broken, his arm is broken, that too can be reduced and mobility and death can also be reduced and effective care is not instituted with in the first over after injury, so in the middle of injury, the patient expires after 1 hour and it is okay with Allah, so what should we do, what should we do to prevent his death, that first hour after the

6:58 golden over, if we have to save the patient by doing something in that, then our guidelines came and this concept of golden over came to us, okay it starts at the time of injury when If there is an injury then an urgent system has to be done in the initial phase of trauma, date can be lived in. So this is our concept that prefer to have a time period lasting for van over and less following a traumatized injury during which there is highest probability possibility that adequate treatment will prevent it. I understand what is golden over, then the chances of survival of the patient

7:44 also increase and rapid intervention is the backbone of this concept in spirit of 60 minutes, it is not that you have been lying down for an hour, half an hour, the end is not over, then I should start as soon as possible, rapid intervention is necessary in this. Now, what are the teams in 80 who together have to support the trauma, so in it there will be a doctor, obviously there will be nurses, there will be operating department, there will be doctor's assistants, there will be radiographers who will reduce all this and then Therefore, it is very expensive and many hospitals cannot support the thing that

8:33 so many people have come. So, because of all this, they have created an organization type, vertical organization and horizontal organization. Now you have to tell me yourself whether vertical organization is good or horizontal. What happens in vertical is that a doctor is seeing many patients and what happens in horizontal is that there are more than one members of the step and they form a team and through that they are seeing multiple patients. So, I created it now, in vertical there is one doctor and many patients and in horizontal there are many doctors who are seeing multiple patients. So you also understand

9:20 which real organization will be there and what is the significant times from this? Did you understand our introduction till now? Now we will read what things we have to see in this. So, there are three steps. There is a secondary survey and what is definitive care? These are very important steps, very important steps and to deal with the patient's life, so what happens in primary survey and recusation is that we have to see the patient, what is killing the patient, we have to identify him, we have to treat him, if we

10:08 identify him then we will treat him, so because of this, the threading problems have to be seen, what are those three things that are killing the patient, he has met with a road traffic accident, he is not breathing, there is bleeding, all these things, breathing circulation in the air, these are the three things that we have to look at in the primary survey and along with that we have to detect them and do resuscitation, how can we do it, if we are not able to save him, he dies then what we have to do is to see what is the matter, is there anything stuck inside, if any airway is blocked, we have to try to open it, we have to

10:54 correct his breathing The circulation needs to be corrected. His blood loss is increasing. For that, fluids need to be given to him. He will be given blood drops and fans. Now, his blood loss has become too much. What is a secondary survey? In this, once we have corrected the breathing circulation of the patient, we have to examine the patient from head to toe. For example, you have a patient, you have done his primary survey well and maintained him, but what happened? For example, his blood was decreasing, okay, and you have not seen him at all. So,

11:41 patient survey is important and a proper examination has to be done so that potentially life-threatening injuries can also be noted from the place of their management. Therefore, primary surface is important but secondary services are also important. Okay, there is definitive care in which a management plan is made. So first of all we will see in primary service care, what all is there, we have come to know a little briefly, now we have gone into their details. First of all, we will see primary survey and resuscitation, in which we have There are three things, breeding circulation, we will see this in a little detail that how to see these three things of the patient and how to manage them, okay, the patient can die instantly due to them,

12:29 for example, the patient can die at that very moment if we do not relieve it, the patient dies, okay and because of this we have to see quickly, there are five components in it, A B C D I is our chain, which in our childhood is A for apple, B for ball, now what is ours, A B C D I, these are the things that you have to remember now, okay, so A for airway maintenance and cervical spine protection, okay, if we just say airway maintenance, then the definition will not be complete, we have to do airway maintenance here and also keep the cervical spine straight, the cervical spine also has to be protected, that is also important, while maintaining the airway, if the coriander of the heart gets up, then both things of the patient have to be seen, B for breeding, breeding and

13:17 Ventilation is both a thing, then C4 circulation, hemorrhage control are both things, so recently I don't talk about calculation, recently I don't talk about breathing, but along with ventilation, hemorrhage control is okay, for example, I did some things, cleaned his spine, stabilized his spine, did everything, okay, the disability, neurological status, the glass was also checked, and yes, have n't you seen that I kept the patient in a cold room, it was so cold there, it was winter season and we kept the patient in winter, even after doing everything, the patient

14:03 died due to hypothermia, so what is the use of your hard work, when you did not control his environment, because of this, A B C, D I are all important, okay, so first of all we will discuss about air way and cervicalis and protection, first of all what we have to do is to do the evaluation, is the patient in front of you, these are also things before the hospital and also till reaching the actual hospital, You have given the ABC of the patient, right? You have to keep him under control. The patient is in his place. You are there. First of all, you have read the patient in front of you. What is the extra patient? What is the name of the patient? You have to ask him something. Have you found out if he is speaking or not? Have you brought him to his senses? Where am I or not? So, you have to ask him simply, what is his name? You have to find out if he is

14:53 conscious or not? If he is unconscious and is not speaking, then we will think that there is some issue going on with him. So, first of all, do the valuation. Okay, only after that, what did we do? We started his management. What is there in the management, we say that before other manipulation, you airway stabilize the cervical spine with the help of rigid cervical collar and placing sand bags on both sides of the head with patients for head tape, cross the bags, bag and line of survival spinal cord, avoid engineering, that is, simply, this. I want to tell you that before looking at the airway, the first thing you need to set is the patient's neck. Okay, his neck needs to be

15:39 stabilized. For that, what we do is we use a cervical collar. Okay, see what we have done here is a step stiff neck collar is placed to stabilize the patient's cervical spine. And you can see sand boxes on the side. Okay, this sand back is placed on the side. What will happen with this is that the patient's neck will be stabilized. Okay, we have set this collar for the cervical. See, after stabilizing its neck, first we will set the cervical collar. We will place the stand and then we will put airbags on the patient. When we have done that, we will do cervical

16:24 stabilization and cervical spine protection. After that, what do we do? We do chain lift or Jyot rest. Why do we do both of these? You should ensure that the airplane is in line. And what difference do we make in these that the What is the difference between the authors that we do head oil and chin lift in those people who are unconscious and the throwest is done in those people who we feel that there is a spinal injury, so this is the difference, so if you hold the chain and start lifting it in a person who has a spanner injury, then there is an issue in that, because of this we should know that we have to suspect this final injury, then we have to give the job rest, then what do we do, we

17:13 lift the chain in the unconscious patient, okay so I will tell you the procedure of what to do in the lift, see, you have to use these two hands, I will also share the video with you, you can see from there in the description in the link, but what has to be done, the finger of one hand place in the mandible, we have to keep two fingers under the table and then what they have to do slowly, the jetli is on the upper left We have to do this so that the mark goes upwards and forwards and the second one we have, okay, means what happens because of it, after that

17:59 you can see that the mouth of this person will open, okay, so we have to keep our thumb on top, that means see, this was on top, we have to take this thumb inside the mouth, okay and place it on the lower inciders, the teeth, okay, so that ours, that is, the tight one, comes outwards and that way, we have to place the thumb behind the lorenzers so that the mouth also opens, means we have two things, one we have to take the chin up and secondly we have to open the mouth, so for the one who is going to take the chin, we will do this with two fingers

18:48 and for doing this, we will open the mouth through the thumb, are you understanding, so what happens with this is that the chin actually opens We have cervical fracture, that can cause cord injury. So because of this, if such a person comes to you and you start lifting the chain directly and you have not stabilized his cervical cord with the help of a biker's belt, then obviously there can be cord injury. That's why we do the cord stabilizer after a lot of thinking and then we

19:34 perform this exercise. The second exercise that we have is okay, what happens in this is that see how we have kept our hands, see the difference between the two. Now see, in this we have kept both hands under the knee, okay, so we keep the lower knee under the one hand side, okay, what will happen with this, it will move forward, okay, when we trust it, that is, we take it upwards, then what happens with this is that along with this we can also attach a bag mask, due to which, one gets tipped in the airway, secondly, if we fit the bag mask inside, then that ventilation will also start getting adjusted, are you understanding, understand the difference between the two things? This is how it has been done, I will add it to you in the video, you can see the

20:20 chain lift there, see how it has been done on one side and the threads [Music] see because of this, how the air bag has opened [Music] was blocked, see how the share is also blocked, as soon as we have opened it [Music] then this benefit is actually there in us during performing, the chain lift was downwards and was done upwards, just like this, okay now we will do the rest in the next part