This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
STH 2017_Day 3_Track 1_Session 1_Caralis_Preventing Medical Errors Compatibil...Benghie Hyacinthe
The document discusses medical errors and strategies to reduce them. It defines medical errors and notes that they are common, causing thousands of deaths annually in the US. Root cause analysis seeks to identify underlying factors in the healthcare system that contribute to errors in order to implement fixes. Strategies discussed include improving communication, using checklists, increasing staff supervision, and optimizing workload and resources to reduce risk. The goal is to learn from errors by examining the system failures that led to them, rather than blaming individuals.
Sentinel events are unexpected occurrences involving death or serious physical or psychological injury or risk. Examples include suicide, wrong-site surgery, and infant abduction. A sentinel event differs from a medical error in its severity of outcome. Organizations are expected to report sentinel events, conduct a root cause analysis to identify causal factors, implement an action plan to reduce risks, and evaluate compliance through the survey process. The goal is to improve patient safety by learning from sentinel events.
The document outlines international patient safety goals and guidelines for incident reporting. It discusses 6 main safety goals, including correctly identifying patients, improving communication, and reducing healthcare-associated infections. It also defines different types of incidents like near misses, adverse events, and sentinel events. For reporting, it specifies the immediate actions required and that all incidents must be reported to the quality department within 24 hours. The purpose is to distinguish between different adverse events to improve patient safety.
This document discusses how to prepare for future epidemiological events through effective personal protective equipment (PPE) training programs. It outlines the key components of PPE required for infectious patients, including different levels of protection (A, B, C, D) depending on the hazard. Effective training programs incorporate both lecture and extensive hands-on practical sessions to ensure staff can properly don, doff, and care for PPE. While no organization can prepare for every potential disease, regular practice in PPE use and team-based simulation exercises will help optimize response when future outbreaks occur.
The document discusses guidelines for transferring trauma patients to higher levels of care. It recommends identifying the need for transfer as early as possible, stabilizing the patient according to ATLS guidelines before transferring, and acting in the best interest of the patient. Facilities should understand their own capabilities and limitations, involve EMS, follow EMTALA regulations, and have transfer agreements in place. The goal is to transfer patients efficiently while providing the highest possible level of care.
Dr. John Snow popularized the use of pain relief during labor when he administered chloroform to Queen Victoria for the birth of her eighth child. The document discusses various methods of pain relief during labor, including non-pharmacological methods like Lamaze breathing techniques, and pharmacological methods like opioids administered parenterally or via neuraxial routes. It also addresses maternal and fetal risks, goals of labor analgesia, and the roles of obstetricians and anesthesiologists in managing labor pain.
Pitfalls in the management of trauma patients2Chew Keng Sheng
The document discusses various pitfalls that can occur in the management of trauma patients, including failure to recognize hemorrhage, errors in diagnosis, and not addressing the lethal triad of hypothermia, acidosis, and coagulopathy which can further exacerbate bleeding and poor outcomes. It provides guidance on properly assessing for shock through vital signs, lab markers, and fluid resuscitation responses and emphasizes the importance of aggressively treating the lethal triad to prevent life-threatening coagulopathy.
STH 2017_Day 3_Track 1_Session 1_Caralis_Preventing Medical Errors Compatibil...Benghie Hyacinthe
The document discusses medical errors and strategies to reduce them. It defines medical errors and notes that they are common, causing thousands of deaths annually in the US. Root cause analysis seeks to identify underlying factors in the healthcare system that contribute to errors in order to implement fixes. Strategies discussed include improving communication, using checklists, increasing staff supervision, and optimizing workload and resources to reduce risk. The goal is to learn from errors by examining the system failures that led to them, rather than blaming individuals.
Sentinel events are unexpected occurrences involving death or serious physical or psychological injury or risk. Examples include suicide, wrong-site surgery, and infant abduction. A sentinel event differs from a medical error in its severity of outcome. Organizations are expected to report sentinel events, conduct a root cause analysis to identify causal factors, implement an action plan to reduce risks, and evaluate compliance through the survey process. The goal is to improve patient safety by learning from sentinel events.
The document outlines international patient safety goals and guidelines for incident reporting. It discusses 6 main safety goals, including correctly identifying patients, improving communication, and reducing healthcare-associated infections. It also defines different types of incidents like near misses, adverse events, and sentinel events. For reporting, it specifies the immediate actions required and that all incidents must be reported to the quality department within 24 hours. The purpose is to distinguish between different adverse events to improve patient safety.
This document discusses how to prepare for future epidemiological events through effective personal protective equipment (PPE) training programs. It outlines the key components of PPE required for infectious patients, including different levels of protection (A, B, C, D) depending on the hazard. Effective training programs incorporate both lecture and extensive hands-on practical sessions to ensure staff can properly don, doff, and care for PPE. While no organization can prepare for every potential disease, regular practice in PPE use and team-based simulation exercises will help optimize response when future outbreaks occur.
The document discusses guidelines for transferring trauma patients to higher levels of care. It recommends identifying the need for transfer as early as possible, stabilizing the patient according to ATLS guidelines before transferring, and acting in the best interest of the patient. Facilities should understand their own capabilities and limitations, involve EMS, follow EMTALA regulations, and have transfer agreements in place. The goal is to transfer patients efficiently while providing the highest possible level of care.
Dr. John Snow popularized the use of pain relief during labor when he administered chloroform to Queen Victoria for the birth of her eighth child. The document discusses various methods of pain relief during labor, including non-pharmacological methods like Lamaze breathing techniques, and pharmacological methods like opioids administered parenterally or via neuraxial routes. It also addresses maternal and fetal risks, goals of labor analgesia, and the roles of obstetricians and anesthesiologists in managing labor pain.
Pitfalls in the management of trauma patients2Chew Keng Sheng
The document discusses various pitfalls that can occur in the management of trauma patients, including failure to recognize hemorrhage, errors in diagnosis, and not addressing the lethal triad of hypothermia, acidosis, and coagulopathy which can further exacerbate bleeding and poor outcomes. It provides guidance on properly assessing for shock through vital signs, lab markers, and fluid resuscitation responses and emphasizes the importance of aggressively treating the lethal triad to prevent life-threatening coagulopathy.
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
GEMC - Medical Student - Trauma - Initial Assessment and Management of Trauma...Open.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
CRITICAL INCIDENT REPORTING IN ANAESTHESIA.pptxOlachiUba1
This document discusses critical incident reporting related to drug errors in anaesthesia. It covers causes of critical incidents including human errors and latent failures. It also discusses components of an incident reporting system including data input, analysis, and feedback. Barriers and enablers to reporting are examined. Drug errors are defined and classified. Risk factors, consequences, and methods for prevention of drug errors are outlined.
CU Errors, clinical governance and patient safetyMedic-ELearning
The document provides an overview of clinical governance, patient safety, and error prevention. It defines key terms like errors, incidents, and near-misses. It describes the National Patient Safety Agency's role in collecting incident reports to identify risks and improve safety. The document also discusses how most incidents are due to failures in systems and processes rather than individuals, and how a culture of learning from incidents can help prevent future harm.
This document outlines patient safety goals and standards. It defines key terms like risk and safety. It lists international patient safety goals such as identifying patients correctly and reducing healthcare associated infections. National patient safety goals are discussed in more detail and include accurately identifying patients, improving caregiver communication, safely using medications, reducing anticoagulant therapy harm, maintaining accurate medication information, reducing clinical alarm hazards, and preventing healthcare associated infections. The document provides specific requirements for implementing several of the national goals.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document summarizes a presentation on patient safety given by Dr. Annush Tha. It discusses the importance of patient safety and human factors in healthcare. It notes that medical errors are a leading cause of death globally and outlines strategies to improve safety, including checklists, reporting systems, and quality improvement. The role of surgeons in ensuring safety throughout the surgical pathway is emphasized. Newer approaches focus on performing procedures correctly from the start rather than just correcting errors.
This document discusses strategies to ensure the safety and wellness of paramedics and their patients. It addresses key threats like motor vehicle crashes, back injuries, and disease transmission. It emphasizes the importance of proper lifting techniques, infection control, health and wellness, and stress management for paramedic safety. For patient safety, it highlights risks of improper transfer or communication, medication errors, airway issues, and ambulance crashes. The document stresses the legal and ethical responsibilities of paramedics to adhere to standards of care, patient rights, and reporting requirements. Finally, it provides an overview of cellular metabolism and the importance of maintaining cellular integrity in emergency medical treatment.
Sociotechnical Aspects: Clinicians and Technology_ lecture 1_slidesZakCooper1
This lecture focused on medical errors and patient safety. It distinguished between individual "slips" and "mistakes" as well as system errors. Several types of medical errors were examined like medication errors and wrong site surgeries. Efforts to improve patient safety through initiatives like medication reconciliation were also discussed. The lecture concluded by reviewing organizations driving improvements in patient safety and quality of care.
This document discusses various topics related to paramedic safety and patient care. It addresses actual safety threats to paramedics such as motor vehicle crashes and back injuries. It provides recommendations for injury prevention including proper lifting techniques and seatbelt usage. The document also discusses ensuring patient safety by preventing medical errors, effective communication during patient handoffs, and following standard precautions. Legal issues related to the paramedic scope of practice and a paramedic's responsibilities are also reviewed.
This document outlines patient safety in healthcare facilities. It defines key terms like patient safety, psychological safety, and safety culture. It discusses the roles of the patient safety committee and the components of a patient safety plan. Specific patient safety issues in the intensive care unit are examined, like collaboration among ICU staff and common errors. International patient safety goals are provided, such as accurately identifying patients and reducing healthcare-associated infections. Root cause analysis is introduced as a way to investigate incidents and prevent future errors.
The document outlines a quality improvement initiative at Sun Coast Regional Hospital to reduce their inpatient fall rate of 50% per 1,000 patients annually. The team aims to reduce the rate by 90% through interventions targeting materials (patient/staff education), physical environment (facility design), and workforce (increasing staffing). They conduct a fishbone analysis, implement interventions using the PDSA model, measure quarterly results, and continue refining interventions such as enforcing footwear/wristband rules and routine physiotherapy checks.
Here are the steps to modify probability from test results:
1) Determine the pre-test probability (prior probability) of disease based on risk factors, symptoms, etc.
2) Determine the likelihood ratios (LRs) for the specific test result:
- Positive LR = Sensitivity / (1 - Specificity)
- Negative LR = (1 - Sensitivity) / Specificity
3) Use the LR to modify the pre-test probability into the post-test probability:
- Post-test probability for positive test = (pre-test odds x positive LR) / (1 + pre-test odds x positive LR)
- Post-test probability for negative test = (pre-test odds x negative LR
This document outlines key topics and approaches for teaching patient safety in pharmacy curriculum. It discusses 11 topics covered in the WHO curriculum guide, including what patient safety is, human factors, learning from errors, and improving medication safety. It emphasizes teaching skills like communication, teamwork, and quality improvement methods. Educational principles discussed include contextualizing examples, identifying practical applications, and integrating topics throughout the curriculum using case studies and skills practice. The goal is to help future pharmacists recognize system failures and errors to prevent patient harm.
This document provides an introduction to patient safety. It defines patient safety as the reduction of unnecessary harm from healthcare. Significant numbers of patients are harmed or die each year from medical errors. The six key dimensions of healthcare quality are discussed, including being safe, effective, efficient, equal, timely, and family-centered. Sources of error include active human errors and latent system errors. A just culture focuses on system flaws rather than individual blame. Clinical incidents encompass adverse events, near misses, and sentinel events. Maintaining safety involves adhering to best practices around issues like hand hygiene, medication reconciliation and falls prevention.
GEMC- Administration: Ethics/ Medicolegal/ EMS/ etc. - Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
More Related Content
Similar to GEMC - Trauma Patient Care in the Emergency Department : Pitfalls to Avoid
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
GEMC - Medical Student - Trauma - Initial Assessment and Management of Trauma...Open.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
CRITICAL INCIDENT REPORTING IN ANAESTHESIA.pptxOlachiUba1
This document discusses critical incident reporting related to drug errors in anaesthesia. It covers causes of critical incidents including human errors and latent failures. It also discusses components of an incident reporting system including data input, analysis, and feedback. Barriers and enablers to reporting are examined. Drug errors are defined and classified. Risk factors, consequences, and methods for prevention of drug errors are outlined.
CU Errors, clinical governance and patient safetyMedic-ELearning
The document provides an overview of clinical governance, patient safety, and error prevention. It defines key terms like errors, incidents, and near-misses. It describes the National Patient Safety Agency's role in collecting incident reports to identify risks and improve safety. The document also discusses how most incidents are due to failures in systems and processes rather than individuals, and how a culture of learning from incidents can help prevent future harm.
This document outlines patient safety goals and standards. It defines key terms like risk and safety. It lists international patient safety goals such as identifying patients correctly and reducing healthcare associated infections. National patient safety goals are discussed in more detail and include accurately identifying patients, improving caregiver communication, safely using medications, reducing anticoagulant therapy harm, maintaining accurate medication information, reducing clinical alarm hazards, and preventing healthcare associated infections. The document provides specific requirements for implementing several of the national goals.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document summarizes a presentation on patient safety given by Dr. Annush Tha. It discusses the importance of patient safety and human factors in healthcare. It notes that medical errors are a leading cause of death globally and outlines strategies to improve safety, including checklists, reporting systems, and quality improvement. The role of surgeons in ensuring safety throughout the surgical pathway is emphasized. Newer approaches focus on performing procedures correctly from the start rather than just correcting errors.
This document discusses strategies to ensure the safety and wellness of paramedics and their patients. It addresses key threats like motor vehicle crashes, back injuries, and disease transmission. It emphasizes the importance of proper lifting techniques, infection control, health and wellness, and stress management for paramedic safety. For patient safety, it highlights risks of improper transfer or communication, medication errors, airway issues, and ambulance crashes. The document stresses the legal and ethical responsibilities of paramedics to adhere to standards of care, patient rights, and reporting requirements. Finally, it provides an overview of cellular metabolism and the importance of maintaining cellular integrity in emergency medical treatment.
Sociotechnical Aspects: Clinicians and Technology_ lecture 1_slidesZakCooper1
This lecture focused on medical errors and patient safety. It distinguished between individual "slips" and "mistakes" as well as system errors. Several types of medical errors were examined like medication errors and wrong site surgeries. Efforts to improve patient safety through initiatives like medication reconciliation were also discussed. The lecture concluded by reviewing organizations driving improvements in patient safety and quality of care.
This document discusses various topics related to paramedic safety and patient care. It addresses actual safety threats to paramedics such as motor vehicle crashes and back injuries. It provides recommendations for injury prevention including proper lifting techniques and seatbelt usage. The document also discusses ensuring patient safety by preventing medical errors, effective communication during patient handoffs, and following standard precautions. Legal issues related to the paramedic scope of practice and a paramedic's responsibilities are also reviewed.
This document outlines patient safety in healthcare facilities. It defines key terms like patient safety, psychological safety, and safety culture. It discusses the roles of the patient safety committee and the components of a patient safety plan. Specific patient safety issues in the intensive care unit are examined, like collaboration among ICU staff and common errors. International patient safety goals are provided, such as accurately identifying patients and reducing healthcare-associated infections. Root cause analysis is introduced as a way to investigate incidents and prevent future errors.
The document outlines a quality improvement initiative at Sun Coast Regional Hospital to reduce their inpatient fall rate of 50% per 1,000 patients annually. The team aims to reduce the rate by 90% through interventions targeting materials (patient/staff education), physical environment (facility design), and workforce (increasing staffing). They conduct a fishbone analysis, implement interventions using the PDSA model, measure quarterly results, and continue refining interventions such as enforcing footwear/wristband rules and routine physiotherapy checks.
Here are the steps to modify probability from test results:
1) Determine the pre-test probability (prior probability) of disease based on risk factors, symptoms, etc.
2) Determine the likelihood ratios (LRs) for the specific test result:
- Positive LR = Sensitivity / (1 - Specificity)
- Negative LR = (1 - Sensitivity) / Specificity
3) Use the LR to modify the pre-test probability into the post-test probability:
- Post-test probability for positive test = (pre-test odds x positive LR) / (1 + pre-test odds x positive LR)
- Post-test probability for negative test = (pre-test odds x negative LR
This document outlines key topics and approaches for teaching patient safety in pharmacy curriculum. It discusses 11 topics covered in the WHO curriculum guide, including what patient safety is, human factors, learning from errors, and improving medication safety. It emphasizes teaching skills like communication, teamwork, and quality improvement methods. Educational principles discussed include contextualizing examples, identifying practical applications, and integrating topics throughout the curriculum using case studies and skills practice. The goal is to help future pharmacists recognize system failures and errors to prevent patient harm.
This document provides an introduction to patient safety. It defines patient safety as the reduction of unnecessary harm from healthcare. Significant numbers of patients are harmed or die each year from medical errors. The six key dimensions of healthcare quality are discussed, including being safe, effective, efficient, equal, timely, and family-centered. Sources of error include active human errors and latent system errors. A just culture focuses on system flaws rather than individual blame. Clinical incidents encompass adverse events, near misses, and sentinel events. Maintaining safety involves adhering to best practices around issues like hand hygiene, medication reconciliation and falls prevention.
GEMC- Administration: Ethics/ Medicolegal/ EMS/ etc. - Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Similar to GEMC - Trauma Patient Care in the Emergency Department : Pitfalls to Avoid (20)
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides an overview of ocular emergencies. It begins with an introduction to the Project: Ghana Emergency Medicine Collaborative and author information. The bulk of the document consists of slides reviewing various eye conditions and emergencies, including styes, chalazions, conjunctivitis, iritis, orbital cellulitis, subconjunctival hemorrhages, and scleritis. Treatment approaches are provided for many of the conditions. The document concludes with a discussion of the eye examination approach and areas to be reviewed.
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This document provides an overview of disorders of the pleura, mediastinum, and chest wall. It discusses several topics in 1-3 sentences each, including costochondritis (inflammation of the costal cartilages), mediastinitis (infection of the mediastinum), mediastinal masses, pneumothorax (air in the pleural space), and catamenial pneumothorax (recurrent pneumothorax associated with menstruation). The document aims to enhance understanding of the major clinical disorders commonly encountered in emergency medicine involving the pleura, mediastinum, and chest wall.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes cardiovascular topics including pericardial tamponade, pericarditis, infective endocarditis, hypertension, tumors, and valvular disorders. It provides details on the causes, signs and symptoms, diagnostic studies, and management of these conditions. The document also includes bonus sections on cardiac transplant patients, pacemakers and ICDs, and EKG morphology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses the evaluation and management of patients with kidney failure presenting to the emergency department. It covers causes of acute kidney injury including pre-renal, intra-renal and post-renal failure. It also discusses evaluation of kidney function, risks of intravenous contrast, dialysis indications and complications in chronic kidney disease patients including infection, cardiovascular issues and electrolyte abnormalities. Special considerations are outlined for resuscitating, evaluating and treating kidney failure patients in the emergency setting.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
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বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
GEMC - Trauma Patient Care in the Emergency Department : Pitfalls to Avoid
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Trauma Patient Care in the Emergency Department :
Pitfalls to Avoid
Author(s): Jim Holliman, M.D., F.A.C.E.P. (Uniformed Services University
of the Health Sciences) 2009
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3. Trauma Patient Care in the
Emergency Department :
Pitfalls to Avoid
Jim Holliman, M.D., F.A.C.E.P.
Program Manager
Afghanistan Health Care Sector Reconstruction Project
Center for Disaster and Humanitarian Assistance Medicine
(CDHAM)
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences (USUHS)
Bethesda, Maryland, U.S.A.
June 2009
3
4. Lecture Objectives:
Review the 5 Pitfalls that Inhibit a
Successful Trauma Resuscitation
1. Discuss how institutional and individual
commitment to the injured patient is
essential.
2. Understand the importance of an
ongoing performance improvement
program in the care of the trauma
patient.
3. Learn how the failure to follow the
fundamental principles of trauma
resuscitation leads to pitfalls.
4
5. Lecture Objectives (cont.)
4. Understand the importance of early
recognition of resource limitation and
transfer to definitive care at an
accredited trauma center.
5. How the tertiary survey prevents missing
injuries.
5
6. Pitfalls in Trauma Resuscitation :
Pitfall # 1
Lack of institutional and individual
commitment to the care of the critically
injured patient
6
7. Question About Pitfall # 1
Can a “non-trauma” General Surgeon and/
or
Non-Trauma Center
render optimal care to the injured patient ?
7
8. Does Volume of Trauma Cases
Matter Regarding Outcomes ?
• “The more you do, the better you are”
• Development of trauma systems, state
designation, and the American College of
Surgeons verification process use
volume as one qualifying criterion for
trauma centers
• There are conflicting reports in the
literature on the impact of volume and
outcome.
8
9. Institutional Outcomes in Rural
Level 3 Centers or Non-Trauma
Centers
• Outcomes were good when :
– Appropriate, functional triage protocols
comparable to national norms were in place
– Clear stipulations and requirements
regarding the process of care were in place
– Ongoing quality assurance or performance
improvement was done
Nathens. Advances in Surgery. 2001.
9
10. Key to a Successful
Trauma Resuscitation
As long as the institution and the staff is
committed to meeting the challenges
involved in the care of the trauma patient,
and have a rigorous performance
improvement process, outcomes will be
successful.
Presence of quality Emergency Medicine at
the institution has also been shown to be
a critical component to achieve good
outcomes.
10
11. Pitfalls in Trauma Resuscitation :
Pitfall # 2
Underdeveloped
Performance Improvement Plan
11
12. Performance Improvement
Programs or Systems
• Are a mechanism to identify “events”,
particularly undesirable ones, prospectively
• Blame and “finger-pointing” are
counterproductive
• These need to be :
– Constructive
– Transparent (No hidden agendas)
12
13. Performance Improvement (PI)
• How “events” can be identified :
– Physician and nursing members should be
on the PI team
– Chart review (ideally 100 % of charts)
– Morbidity and Mortality review conferences
• Should have participation by representatives of
all departments involved in trauma care
– Quality Assurance Committees
13
15. Determination Classification
• Systems-related example :
– Delay in IV access
• Central lines then needed
• Disease-related example :
– Respiratory failure
• Due to multiple rib fractures and pulmonary
contusion
• Provider-related example :
– Pulmonary embolus in an admitted patient
• No DVT prophylaxis was prescribed
15
16. Grade Classification
• Grade 0
– No complication
• Grade 1
– Expected complication; within the standard of care
• Grade 2
– Unexpected; within the standard of care
• Grade 3
– Unexpected; deviation from standard of care
• Grade 4
– Unexpected; Gross deviation from the standard of
care
16
18. Performance Improvement
Operation
•
•
•
•
Develop action plans
Assign accountability
Track and Trend in a measurable way
Re-analyze your progress
– Fine tune your action plan,
– Continue to monitor, or
– Determine that the action plan has been
successful.
18
19. Pitfalls in Trauma Resuscitation :
Pitfall # 3
Failure to follow the fundamental
principles of resuscitation.
Usually Provider-related
Usually during the Primary Survey
19
20. Reminder of the Primary
Survey Sequence
•
•
•
•
•
Airway (with cervical spine immobilization)
Breathing (oxygenation and ventilation)
Circulation with hemorrhage control*
Disability
Exposure and Environment
*Note that in the military or
battlefield environment, hemorrhage
control is taught to be the top and
first priority
20
21. Airway Pitfalls to Avoid
• Delay in recognizing the compromised
airway
• Visual Cues missed :
– Comatose (Glasgow Coma Score 8 or less)
– Combative / Agitated / Altered Mental Status
• Hypoxia
• Drugs / Alcohol
• Traumatic brain injury
– Emesis and /or blood in the airway
21
22. Aggressive Airway Management
to Avoid Airway Pitfalls
• The risks are fairly small
• Rapid sequence intubation
– Avoid aspiration
– Use techniques to keep intracranial pressure low
• Maintain in-line cervical spine immobilization
– Avoid cervical spine injury
• Apply cricoid pressure
– Avoid aspiration
• You will rarely be questioned for this decision
• You can always extubate the patient later
22
23. Airway Pitfalls to Avoid (cont.)
– Delegation of difficult airways to the least
experienced :
• Physician Assistant, residents, nurse anesthetists
– Delay in mobilization of the most skilled personnel
for airway control :
• Varies among institutions (Emergency Medicine,
Anesthesia, Trauma)
– Dismiss expert or senior help from the
resuscitation too early.
23
24. Breathing Related Pitfalls to
Avoid
• We know needle thoracentesis before chest
tube, and chest tube before chest X-ray, for
any case of suspected tension
pneumothorax.
• Failure to recognize hypoxia early
24
25. Breathing Pitfalls to Avoid
(cont.)
• Attention is not paid to the visual cues :
• Pallor
• Cyanosis
• Altered mental status
• Pulse oximeter reading falling or not
tracking
25
27. Breathing Pitfall Reminder
• For Traumatic Brain Injuries, avoid :
– Hypoxia
– Profound hyperventilation
• Keep the pCO2 in the low to mid 30’s
27
28. Circulation Pitfall to Avoid
Problem # 1
Failure to engage or recognize patients
that are in profound, decompensatory
shock and to initiate timely, appropriate
treatment
28
29. Failure of Non-Operative Management
of Splenic Injury :
An Example of a Circulation Pitfall
• Eastern Association for the Study of Trauma :
multicenter, retrospective study
• 78 adult patients who failed non-operative
management
• 17 trauma centers in the U.S. in 1997
• 8 CT scans were misread initially
• 42 % (11/26) ultrasounds were false negative
29
30. Failure of Non-Operative Management of
Splenic Injury :
An Example of a Circulation Pitfall (cont.)
• 37 % failed during the first 12 hours
• 30 % had hypotension that responded to
fluid resuscitation
• 25 % were persistently tachycardic or
hypotensive (p< 0.05)
• Ten patients died (12.8 %)
• 2/3 who died from exsanguination never
underwent laparotomy.
30
31. Circulation Pitfall (cont.)
40 % of non-operative failures
of the spleen were triaged
inappropriately with misleading
abdominal CT scans or
ultrasound interpretation,
or hemodynamic instability
31
32. Another Circulation Pitfall
Problem # 2
Failure to transfuse blood products early, and
to track the amount of crystalloid given.
Remember, the standard initial infusion is :
2 liters crystalloid in the adult,
20 ml/kg x 2 to 3 boluses in the child.
32
33. Circulation Pitfalls (cont.)
Problem # 3
Use of pressors in hemorrhagic shock.
Should only be used for patients in
neurogenic shock, and only then if there
is poor response to initial fluid infusion.
33
34. Circulation Pitfalls (cont.)
Problem # 4
Spending too much time
doing resuscitation-related procedures
that could be better performed
in the operating room
Examples :
Central and arterial line insertions
Foley catheter placement
Nonessential Radiographic studies
34
35. Circulation Pitfalls (cont.)
Problem # 5
Lack of early surgical consultation for patients
demonstrating signs and symptoms of shock.
Establish a culture that physician-to-physician
communication is not a sign of weakness.
Upgrade care if needed.
35
36. “D” in the Primary Survey :
Disability Pitfalls to Avoid
In the last 30 years, early trauma deaths in the
“Golden Hour” are mainly due to :
Hemorrhagic Shock
Traumatic Brain Injury
36
37. Disability Pitfalls to Avoid
• Avoid secondary brain injury :
– Treat hypoxia and hypotension aggressively
• Avoid vigorous hyperventilation
• Do not perform CT scans of the head if there is
no neurosurgeon available
– Rapid transfer preferable
• Consider steroids early for Spinal Cord Injury:
– Clarify with accepting physician if steroids should
be started if you are uncertain
37
38. “E” in the Primary Survey : Exposure /
Environment Pitfalls : Hypothermia
• Is a preventable complication
• Preventive measures :
– Keeping fluids warm in an incubator
– Transfusing blood through a warmer
– Keep the resuscitation area warm
• Limit traffic in and out of room
– Warming blankets and lights
– Keep patient covered when exam is done
• Particularly high heat exchange areas like the scalp
38
39. Hypothermia : Importance of
Prevention
• Hypothermia-induced coagulopathy
– Marked bleeding diathesis
• Death Triad :
– Hypothermia
– Coagulopathy
– Acidosis
Hypothermia has been shown to
directly increase trauma mortality
several fold
39
40. Pitfalls in Resuscitation :
Pitfall # 4
Failure to recognize local resource
limitations and make an early decision to
transfer to definitive care.
All U.S. trauma centers track transfers
which occur > 3 hours from time of
arrival.
40
41. Audit Filters Used to Track
Potential Transfer Pitfalls
• Delay to laparotomy ( > 2 hours)
• Delay to craniotomy ( > 4 hours)
• Delay to Operating Room for open
fractures ( > 8 hours)
41
42. Transfer to Definitive Care :
Special Considerations
• Extreme age
– Age > 55 is considered “geriatric trauma”
• Significant comorbidities
• Anticoagulation therapy
Patients with any of these require
higher levels of trauma care
42
43. Transfer to Definitive Care :
Special Considerations (cont.)
• Solid Organ Injury
– Large amount of hemoperitoneum
– Contrast blush
– Anticoagulation
– Age > 55 years
Patients with any of these require
higher level trauma care
43
44. Pitfalls In Trauma Resuscitation
Pitfall # 5
Failure to perform a Tertiary survey to
prevent missing injuries.
(meaning a complete, comprehensive,
head to toe re-exam for injuries)
44
45. Study Showing the Value of the
Tertiary Survey
§ B.L. Enderson ; Univ. of Tennessee
§ 3-month study ; 399 trauma patients
§ 89 % blunt etiology
§ To find missed injuries :
§ Complete re-examination
§ Head to Toe
§ Within 24 hours of admission
45
47. Tertiary Survey
Factors Contributing to Missed Injuries in
the Tennessee Study
Closed Head injury
ETOH / Drugs
Combative / Intubated
Unstable
No signs / symptoms
Non-ambulatory
Low index of suspicion
Quadriplegic
Technical Error
25
15
7
4
4
3
2
1
1
47
48. Tertiary Survey Discovery of
Additional Injuries
Discovered within 24 hours : 35%
Discovered within first week : 68%
Discovered within two weeks :
97%
Discovered > one month :
One injury
48
49. Trauma Care Pitfalls
Lecture Summary
• Personnel and institution commitment is key
to providing high level trauma care
– Performance Improvement
– Careful, compulsive performance of resuscitations
– Recognition of early resource limitation requiring
early patient transfer
– Routine performance of a tertiary survey to try to
avoid missing injuries
49