ACEM 2011_Medical transport in trauma ekkit

820 views
620 views

Published on

For ACEM 2011 participation : Critical Care transfer

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
820
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
26
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

ACEM 2011_Medical transport in trauma ekkit

  1. 1. Medical Transport in Trauma Ekkit Surakarn,M.D General Surgery Aviation Medicine Emergency Department
  2. 2. Stabilized patient – Fit to fly  A - Airway secured  B - Breathing with O2 +/- support Pneumothorax drained  C - Bleeding controlled, Shock treated  D - Deformity immobilized  E - Coverage
  3. 3. Flight factor  Change in altitude  Vibration  Motion  Limited resource  Limited space BE PREPARED.
  4. 4. Flight factor Change in altitude  Lower oxygen = Hypoxia  Gas expansion  Pneumothorax  Lung cyst / bleb  Bowel gas  Middle ear  Diving / Decompression sickness
  5. 5. Flight factor  Vibration & Motion  Team : Vertigo, Motion sickness  Patient : Pain / Injury  Equipment : Displaced / Damage  Limited resource  Oxygen / Drugs  Equipment  Space
  6. 6. Teamwork Flight Doctor Payor or Specialist Airline Staff Flight Nurse Patient and Family
  7. 7. Equipment
  8. 8. What are possible injury ???
  9. 9. Burn – Burn – Burn
  10. 10. Monitor and Observation
  11. 11. Airway Injury Risk Prevention Noise - Unable to check breath sound ET Tube malposition , Pneumothorax  Secure airway Straps + Tape + Marking  Confirm ET Tube Position End Tidal CO2 Monitoring  Pulse Oximeter
  12. 12. End tidal CO2
  13. 13. Airway Injury Risk Prevention Movement and Vibration  Close observation  Secure airway  Recheck – After each movement  End Tidal CO2 Monitoring  Pulse Oximeter
  14. 14. Cricothyroidotomy
  15. 15. C spine immobilization ?
  16. 16. C-Spine and ET Tube Fixation
  17. 17. Breathing - Chest Injury  Air Leak – Tension Pneumothorax  Bleeding – Massive Hemothorax  Deformity Flail Chest / Open Chest Wound  Lung Contusion – ARDS / Pneumonia  Pain – Limited breathing and Cough
  18. 18. Pneumothorax
  19. 19. Pneumothorax Needle thoracostomy  TENSION to SIMPLE  Large bore needle  2nd intercostal space Midclavicular line  One-way valve Under water tube
  20. 20. Needle + One-way Valve + Container
  21. 21. Breathing - Chest Injury Preflight Plan - Risk Prevention  Drainage  Any pneumothorax … Before  Monitoring  Chest symptoms  Chest movement  V/S  SpO2
  22. 22. ICD
  23. 23. Breathing - Chest Injury Chest Pain Limited chest movement  Breathing – Inadequate >>> Atelectasis  Cough – Ineffective >>> Secretion Preflight Plan - Adequate pain control  Epidural block  Analgesic
  24. 24. One-way valve
  25. 25. Breathing - Chest Injury Hemothorax Bleeding in pleural cavity  Chest wall / Lung  Great vessels / Heart Preflight Plan – Stable with Patent ICD  Blood < 100 ml/hr  IVF / Blood products
  26. 26. Breathing - Chest Injury Chest Surgery CVT, ICD, Thoracentesis Preflight Plan  Fly with ICD - Safe  Fly without ICD  No residual air leak – CXR ???  Low risk of leak in flight : 1-2 Week  Prepare for E-Decompression
  27. 27. Bilateral Pneumothoraces
  28. 28. Bilateral Pneumothoraces
  29. 29. Hemopneumothorax
  30. 30. Bilateral Pneumothoraces
  31. 31. Respirator circuit
  32. 32. O2 – Ventilator - Suction
  33. 33. O2 needed, How much?
  34. 34. C - Circulation
  35. 35. Circulation Preflight Plan - Blood  Secure hemostasis … Before flight  Bleeding control  Coag. – FFP/ Cryo / Novo 7  Keep Hb > 7 – 8.5 gm% In trauma > 10 gm%  Occult ongoing blood loss  Cardio / Respiratory Reserve
  36. 36. Circulation Preflight Plan - Volume  Euvolemia  Stable = Controlled hypotension is OK.  No dehydration  Urine output 0.5ml/kg/hr  IVF – Crystalloid, Colloid, Blood  Secure venous access  2 good lines – Large / Patenty checked
  37. 37. Fit to fly ?  Liver injury  Hemopericardium  Burn at chest wall  Post cardiac arrest
  38. 38. Transfusion Rx
  39. 39. Preflight preparation
  40. 40. POCT Point of Care Test  Blood sugar  PT & INR
  41. 41. PASG Application  Standby  Before move  Shock > Inflate
  42. 42. Urine output
  43. 43. Circulation Preflight Plan - Perfusion  Inotropes types – Mixed component  All  Vasoconstriction – NO FLOW  Keep warm  IVF/Blood Products  Blankets
  44. 44. Circulation On board  Check : venous access sites  Monitor  P, BP, SpO2  Conscious  Cap. Refill – Central / 2 sec  Urine Output
  45. 45. Tubes and Lines
  46. 46. Deficit – Brain injury Check list  A-B-C  Initial assessment – AVPU or GCS  Localizing signs  Associated injury – Face/Neck  C-Spine protection  T-L Spine protection  Monitoring : BP and Neuro signs
  47. 47. Bleeding – Contusion - Swelling
  48. 48. Secondary Injury CPP = MAP – ICP Intracranial SOL / Swelling  MAP is normal.  ICP is high.  CPP is LOW !!! Systemic Perfusion – OK. Brain – Shock ???
  49. 49. Save Body & Brain A–B–C–D  Airway Control  Breathing & Oxygenation  CPP : keep MAP  Decrease demand Fever – Fighting – Fit
  50. 50. Pneumocephalus – Tension ???
  51. 51. Pneumocephalus
  52. 52. Requirement : Brain injury Medical staff - Competency in  Neuro. assessment + Consultation  Basic airway technique  Definite airway procedure  Ventilation support  Monitoring  Spine immobilization
  53. 53. Recheck • Neck Pain • Motor Power • Sensory • Pulse Rate • Blood Pressure
  54. 54. Spinal protection
  55. 55. Immobilization
  56. 56. Fx : Femur – T Spine – C Spine
  57. 57. Deformity – Limb injury  Immobilization  Distal perfusion  Compartment syndrome  Cast  Vascular injury  Reperfusion injury  DVT
  58. 58. Immobilization – Traction Splint
  59. 59. Non-constricted immobilizer
  60. 60. Compound fractureVascular injury and limb ischemia
  61. 61. Pelvic fracture with C-Clamp
  62. 62. Pelvic fracture with Binder
  63. 63. Burn
  64. 64. Burn Problems A – Airway  Swelling  Difficult / Obstruction B – Breathing  Inhalation Injury & ARDS  Increase Systemic Injury  Carbon monoxide + Gaseous toxicity  Body Eschar – Chest Movement
  65. 65. Burn Problems C – Burn Shock  20% BSA in Adult  Less in Child/Elderly  Systemic Response  Leak  Depressed Myocardial Fn.
  66. 66. Burn Problems C – Distal Circulation  Tissueswelling  Circumferential Burn  Compartment Syndrome  Circum. Dressing
  67. 67. Burn or more ??? Associated Injury  Burn and fall, car accident, ….  Electrical Injury to … Muscle, Heart, Neuro - Cord, Lens …..  Bleeding  Debridement  Escharotomy  Fasciotomy  Myoglobinuria  Heat loss – Cold IVF
  68. 68. Burn Care – On board  Airway – Swelling  ET Tube ? – Do it on the ground  Breathing – Hypoxia  Ventilator / O2 in flight  Circulation  V/S – Limb swelling : NIBP ?  Urine output
  69. 69. Burn Care – On board  Distal Limb – Swelling  Circumferential Wound  Circum. Dressing Monitor  Distal pulse/Cap. Refill – SpO2  Sensory / Motor  Bleeding
  70. 70. Abdominal Distension
  71. 71. AbdominalCompartmentSyndrome
  72. 72. Rectal Tube
  73. 73. Decompression Tube

×