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Current trauma manag, trauma system


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Current trauma management

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Current trauma manag, trauma system

  1. 1. Current Trauma Management Where Are We? Trauma System By Mr. Mahmoud Abdulkareem M.S {Cairo} , FRCS {Glasgow} Consultant Surgeon, King Fahad Specialist Hospital
  2. 2. Sunday, October 16, 2016 3 Damage Control Resuscitation By DR. Mahmoud Abdulkareem M.S {Cairo} , FRCS {Glasgow} Consultant Surgeon, King Fahad Specialist Hospital
  3. 3. Trauma is the most common cause of death in patients aged less than 40 years
  4. 4. Injuries Injuries result from acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals, and ionizing radiation in amounts or at rates above or below the threshold of human tolerance. R T As account for most injuries Followed by assaults, drownings, falls, burns.
  5. 5. Trauma Trauma is the study of medical problems associated with physical injury.
  6. 6. The trauma patient The trauma patient has been defined as “an injured person who requires timely diagnosis and treatment of actual or potential injuries by a multidisciplinary team of health care professionals, supported by the appropriate resources, to diminish or eliminate the risk of death or permanent disability.”
  7. 7. Mortality is not the only side of this issue; for every trauma victim who dies, at least six are seriously injured The scope of trauma as a problem
  8. 8. Editors: Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright ©2008 McGraw-Hill
  9. 9. THE NEED FOR TRAUMA SYSTEMS— HISTORY…. cont. However, trauma is not yet recognized as a disease process. Many people still think of trauma as an accident.
  10. 10. “the neglected disease of modern society.” THE NEED FOR TRAUMA SYSTEMS—HISTORY…. cont. National Research Council: Accidental Death and Disability: The Neglected Disease of Modern Society. Washington, DC: U.S. Government Printing Office, 1966.
  12. 12. MODERN TRAUMA SYSTEM DEVELOPMENT…. cont. By 1975, Germany had established a nationwide trauma system, so that no patient was more than 15–20 minutes from one of these regional canters.
  13. 13. ATLS was developed as a protocol for the management of Trauma victims
  14. 14. MODERN TRAUMA SYSTEM DEVELOPMENT…. cont. The landmark report of the Royal College of Surgeons (1988) on the management of patients with major injuries highlighted serious deficiencies in trauma management in the United Kingdom. Led to the introduction of the ATLs in the UK.
  15. 15. The trimodal distribution of trauma deaths
  16. 16. The second peak of approximately 30% of all deaths occurs during the initial hours post injury and preventing these deaths were initially the goal of modern trauma care, such as is taught through the Advanced Trauma Life Support (ATLS) course. The Goal
  17. 17. MODERN TRAUMA SYSTEM DEVELOPMENT…. cont. Studies of trauma systems have shown that: Salvage of the critically injured patient is optimized by a coordinated team effort in an organized trauma system. And that: when severely injured patients are treated in specialized trauma centers, patients have greater chances of survival. (Cales 1984; Cales and Trunkey 1985; Guss, Meyer, Neuman, et al. 1989; Shackford et al. 1986; Smith et al. 1990; West, Cales, and Gazzaniga 1983).
  20. 20. The trimodal distribution of trauma deaths
  21. 21. Injury preventi on has become an essential focus for all trauma systems prevent ion
  22. 22. Fundamental phases 1. Injury prevention has become an essential focus for all trauma systems in order to proactively reduce the impact of injury. Many systems have developed formal injury prevention programs and dedicated centers to better address this need. 2. Pre-hospital care includes community access and communication systems as well as EMS systems and triage protocols. Universal access to emergency care (i.e., 911) is essential to allow efficient activation of the system. 3. Acute care facilities provide a range of injury management from initial stabilization and transfer to all-inclusive definitive care. Based on available resources, facilities are characterized by injury management capabilities and many are designated as trauma centers using a scale of 1 to 4, with Level 1 centers providing the most comprehensive level of care. Successful trauma systems benefit from the contributions of all available facilities to become more inclusive and to provide consistent care to all people within the system. 4. Post-hospital care is an important part of reducing disability and improving an injured patient's long-term outcome. Efficient transfer from the acute care setting to rehabilitation is a necessary attribute of a well-developed trauma system. West JG, Williams MJ, Trunkey DD, et al.: Trauma systems: Current status future challenges. JAMA 259:3597, 1988.
  23. 23. conditioning
  24. 24. Prehospital Carecont. Critically injured patients must receive high-quality care from the earliest postinjury moment to have the best chance of survival.
  25. 25. Triage: the aim is to provide optimum care to maximum No of pt. by ensuring that they are treated in order of need so that pt. with severe injury that is potentially survivable are given priority of care. The most experienced person present should carry out triage. Prehospital Care ….cont.
  26. 26. Advanced life support is provided [by an organized trauma team] Early hospital phase:
  27. 27. Phases of management of the injured patient
  28. 28. Principles of Initial Trauma Management • Organized team approach 1. Complexity of multiple trauma patients 2. Trauma victims are best managed by a team approach • Assumption of most serious injury 1. assume that the worst possible injury has occurred and act accordingly until the diagnosis is confirmed • Treatment before diagnosis 1. urgency of situation often demands treatment based on an initial brief assessment • Thorough examination 1. initial survey of vital organ systems, followed by resuscitative interventions 2. Most missed injuries occur in unconscious patients • Frequent assessment 1. helps detecting early changes in physical findings and thus lead to prompt corrective actions • Prioritisation, optimisation, anticipation and planning are keys to success
  29. 29. Trauma Team Definition The trauma team is an organized group of professionals who perform initial assessment and resuscitation of critically injured patients. Team composition, level of response, and responsibilities of each member are institution-specific. Personnel are outlined as follows: 1. Trauma surgeon—a general surgeon with demonstrated training and interest in trauma care. In designated trauma centers, the trauma surgeon typically functions as the trauma team leader. 2. Emergency medicine physician—in many hospitals, the emergency medicine physician functions as the trauma team leader depending on the perceived severity of injuries. Ideally, these physicians have Advanced Trauma Life Support (ATLS) certification. 3. Anesthesiologist—a physician with special skills in airway management, sedation, and analgesia. In many trauma centers, this role may be fulfilled by a certified registered nurse anesthetist 4. Trauma nurses—emergency department nurses with specialized training and demonstrated interest in trauma care. 5. Resident physicians—residents in emergency medicine or surgery and trauma fellows may assume active roles in the trauma team. In Level I and II trauma centers, senior surgical residents and trauma fellows may function as trauma team leaders. 6. Respiratory therapist—therapist available to assist in the evaluation and management of the patient's respiratory status. 7. Radiology technicians—technicians available to obtain x-rays as indicated by the initial assessment and secondary survey. 8. Surgical subspecialists—although not typically involved in the initial assessment, surgical consultants (e.g., orthopedic surgeons, neurosurgeons) are vital members of the trauma team. 9. Other personnel—the trauma team may also include OR nurses, laboratory technicians, ECG technicians, chaplains, social workers, transport personnel, and case managers.
  30. 30. Hospital trauma team transferring a new patient.
  31. 31. The rapid sequence intubation team
  32. 32. Original article Impact of a multifunctional image-guided therapy suite on emergency multiple trauma care T. Gross1, P. Messmer1,7, F. Amsler5, I. Fu¨ glistaler-Montali1, M. Zu¨ rcher2, R. W. Hu¨ gli1,6, P. Regazzoni1,3 and A. L. Jacob1,4 British Journal of Surgery 2010; 97: 118–127 Conclusion: Implementation of a MIGTS in the emergency treatment of multiple trauma significantly accelerated the procedure and reduced the number of in-hospital transports.
  33. 33. ATLS overview • Preparation • Triage • Primary Survey (ABCDE’s) • Resuscitation • Adjuncts to primary survey and Resus. • Secondary Survey • Adjuncts to Secondary survey • Continued post-resus monitoring • Definitive Care
  34. 34. Care in a trauma system consists of many phases: surgical phase Damage Control
  35. 35. Damage Control Surgery 1. Control hemorrhage 2. Stop further contamination 3. Rapid closure or open packing 4. Resuscitation in SICU 5. Return to OR in 24-48 hours for definitive repair. IN A TRAUMA PATIENT who is hemorrhaging, increased risk of death arises from a vicious cycle of hypothermia, coagulopathy, and metabolic acidosis known as the triad of death.
  36. 36. Trauma Handbook of the Massachusetts General Hospital, The, 1st Edition Care in a trauma system consists of many phases: I C U phase Unique Critical Care Issues Related to Trauma