Anesthesia for multiple trauma: from the scene to the OR
|
|
|
- Randolf Anderson
- 5 years ago
- Views:
Transcription
1 Anesthesia for multiple trauma: from the scene to the OR Gary Hartstein,, M.D. Service d'anesthésie-réanimationsie-réanimation Service des Urgences CHU Liège B Liège
2 Course outline philosophy of trauma care ATLS principles pre-hospital phase emergency department phase operating room phase
3 Philosophy of trauma care trauma is a surgical disease trauma requires a team approach at all phases pre-hospital emergency department operating room intensive care unit
4 Philosophy of trauma care trauma is a dynamic process TEMPORAL EVOLUTION primary lesion(s) secondary lesion(s) "GEOGRAPHIC" EVOLUTION site emergency department OR ICU patient factors response to therapeutic interventions requires constant re-evaluation evaluation
5 Philosophy of trauma care AVOID AVOIDABLE DEATH AND DISABILITY
6 Trimodal death distribution Number of deaths Immediate deaths Early deaths Late deaths (hours) (weeks)
7 Course outline philosophy of trauma care ATLS principles pre-hospital phase emergency department phase operating room phase
8 ATLS principles Advanced Trauma Life Support trauma kills in reproducible time-frames "ABCDE" approach priorities established according to risk emphasize first hour after injury SYSTEMATIC approach to trauma victim
9 ATLS sequence of care primary survey resuscitation secondary survey continuing monitoring and re-evaluation evaluation definitive care A B C s
10 PRIMARY SURVEY The "ABCs" of ATLS Airway (with cervical-spine control) Breathing Circulation (with control of hemorrhage) Disability Exposure (with temperature control)
11 Course outline philosophy of trauma care ATLS principles pre-hospital phase emergency department phase operating room phase
12 Goals of pre-hospital care AVOID SECONDARY VICTIMS minimize secondary lesions secure airway, provide O 2, ensure ventilation packaging provide necessary analgesia prepare receiving hospital provide MEDICAL care
13 Limitations of pre-hospital care "scoop and run" vs. "stay and play" clear tendency to OPTIMISE scene time physiologic normality is NOT goal example: (exsanguinating) hemorrhage increased mortality with fluid therapy increased ICU complications concept of "permissive" hypotension"
14 spinal stabilization Practical aspects rigid cervical collar, KED, vacuum mattress, spine board analgesia / sedation potent opioids, titrated to effect low-dose ketamine midazolam for amnesia, anxiolysis anesthesia indications, choice of agents preparation (!!!)
15 Prepare / choose receiving hospital closest appropriate facility (burns, cardio- thoracic trauma, neurosurgery, etc) transmit necessary information: time of injury related events patient history mechanism of injury initial status and response to treatment estimated time of arrival
16 Course outline philosophy of trauma care ATLS principles pre-hospital phase emergency department phase operating room phase
17 Primary survey AIRWAY (with C-spine C control) identify obstruction (inspect, palpate) maneuvers: jaw thrust > chin lift, suction devices: oral airway, nasopharyngeal airway definitive airway control cervical-spine protection neutral position, alignment of head-neck-trunk immobilization
18 Resuscitation: airway control definitive control: endotracheal intubation indications for intubation obstruction unresponsive to maneuvers S p O 2 < 90% on supplemental oxygen shock (e.g. Bp syst < 90 mm Hg) head injury / unconsciousness (GCS 8) anticipated surgery with multiple injuries agitation rendering care difficult
19 Intubation technique: trauma patients
20 C-spine protection MANUAL immobilization when collar off ASSUME c-spine injury with trauma depressed level of consciousness blunt injury (esp. above clavicle) spine not cleared until: full, adequate neurologic exam AND full, adequate radiology studies (helical CT scan with reconstruction, classic RX - 5 views!!!)
21 Primary survey BREATHING inspection, palpation, percussion, auscultation primary survey seek LIFE THREAT tension pneumothorax flail chest (pulmonary contusion) open pneumothorax massive hemothorax
22 Resuscitation: breathing tension pneumothorax needle decompression (14 G, 2 ICS, mid-clav line) flail chest analgesia, humidified O 2, intubation, CMV open pneumothorax closure (3 sides), chest drainage, intubation, CMV massive hemothorax chest drain with SIMULTANEOUS fluid therapy
23 Resuscitation: breathing 100% O 2 to ALL patients non-rebreathing mask with reservoir l/m flow
24 Primary survey CIRCULATION (with hemorrhage control) predominant cause of treatable deaths hypotension = hypovolemia until proven otherwise rapid assessment of hemodynamic status LEVEL OF CONSCIOUSNESS PULSE (central and peripheral, bilaterally) skin color, capillary refill, temperature identify and control EXTERNAL hemorrhage
25 Grades of shock Class Blood loss ml (%) I 750 ( 15%) II 750 Š 1500 (15 Š 30%) III 1500 Š 2000 (30 Š 40%) IV > 2000 (> 40%) Pulse > 100 Syst-diast BP
26 Severe shock either NON-HEMORRHAGIC tension pneumothorax tamponnade neurogenic ( spinal ) ) shock or HEMORRHAGIC external internal
27 IT S S THAT SIMPLE!!!
28 Shock: internal bleeding either thorax and/or abdomen and/or pelvis THORAX: chest drainage, operation NO FURTHER WORKUP IF STILL SHOCKED ABDOMEN: laparotomy NO FURTHER WORKUP IF STILL SHOCKED PELVIS: reduce pelvic volume, ortho consult
29 IT S S THAT SIMPLE!!!
30 Resuscitation: circulation 2 large bore peripheral venous catheters at least 16 gauge remember external jugular, femoral veins problematic access: interosseous (adult & child) draw labs: heme, coag, T&X, tox, β-hcg
31 Resuscitation: fluid therapy hypotensive: BLUNT trauma adult: up to 2 liters warmed lactated Ringer's child: up to 2 x 20 ml/kg warmed lactated Ringer's inadequate response: TRANSFUSE; ; consider O.R., other diagnoses hypotensive: PENETRATING THORACO- ABDOMINAL airway, 100% O 2 venous access tolerate Bp syst 70 mm Hg until controlled (O.R.)
32 Primary survey DISABILITY (neurological evaluation) pupils: symmetry, reactions GCS (Glasgow Coma Score) eye opening verbal response motor response
33 Primary survey EXPOSURE (with environmental control) fully undress victim MAINTAIN CORE TEMPERATURE warm blankets warmed fluids warm environment
34 Intra-hospital transfers / transport pre-arrival preparation sufficient help anesthesia personnel nursing personnel sufficient supplies (warmed) fluids drugs oxygen sufficient communication proper monitoring MAINTAIN NORMOTHERMIA
35 Radiology: unstable patient abdominal / cardiac / thoracic ultrasound (F.A.S.T.) standard X-raysX lateral cervical spine (include C7-T1 interspace) IF TIME PERMITS AP pelvis IF CLINICAL SUSPICION immediate surgery?
36 Radiology: stabilized patient stabilized by SMUR or in ER intubated / sedated ± 3 standard X-rays X (CXR, AP pelvis, lat'l C/S) "body - scan" (+ spiral scan cervical spine) full radiological imaging (spine in toto + sites of suspected bony injury)
37 Radiology: stable patient full standard imaging (include spine in toto) body scan (even without obvious lesions) pedestrian vs. car fall > 6 meters frontal collision ejected from car OR car vs. motorcycle death OR serious injury in same vehicle
38 Course outline philosophy of trauma care ATLS principles pre-hospital phase emergency department phase operating room phase
39 Rapid "pre-anesthetic assessment" A llergies M edications P ast illnesses L ast meal E vents related to the injury
40 Operating room: practical aspects re-verify ABCs, organize lines, take report ALWAYS full stomach often difficult intubations maxillo-facial trauma secretions / blood / vomitus conflicting priorities common intracranial hypertension + systemic hypotension agitated patient with difficult airway
41 Anesthetic technique: suggestions severe shock 100% O 2 muscle relaxant analgesic as tolerated (titrated doses opioid) THEN amnesic as tolerated (e.g.. BZD, low dose volatile agent) THEN anesthesia as tolerated
42 Anesthetic technique: suggestions mild - moderate hypotension 100% O 2 etomidate OR ketamine muscle relaxant titrated opioid low dose inhalation anesthetic (increase as tolerated) OR low dose propofol infusion (increase as tolerated)
43 Anesthetic technique: suggestions isolated intracranial hypertension 100% O 2 propofol (2-3 3 mg/kg) OR thiopental (3-5 5 mg/kg) µg/kg sufentanil or equivalent 1.5 mg/kg lidocaine IV (90 sec before intubation) avoid N 2 O continuous propofol infusion (low dose inhalational agent)
44 Operating room: practical aspects major trauma cases one anesthesia team leader one anesthetist per infusion line one "secretary" keep infused fluid containers for post-op op totals anticipate needs transfusion requirements (esp. massive transfusion) ICU bed AVOID HYPOTHERMIA
45 Operating room: surgical priorities torso injuries with hypotension (±( simultaneous) intracranial mass lesions peripheral vascular injuries orthopedic injuries maxillo-facial trauma
46 QUESTIONS? GMH
European Resuscitation Council
European Resuscitation Council Incidence of Trauma in Childhood Leading cause of death and disability in children older than one year all over the world Structured approach Primary survey and resuscitation
Pre-hospital Trauma Life Support. Rattiya Banjungam Emergency Physician, Khon Kaen Hospital
Pre-hospital Trauma Life Support Rattiya Banjungam Emergency Physician, Khon Kaen Hospital Golden principles of Prehospital Trauma Care Golden Hour There is a golden hour if you are critically injured,
Chapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing
1 2 3 4 5 6 Chapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing D-Disability Chief complaint and/or Mechanism
ATLS: Initial Assessment and Management. SAUSHEC Medical Student Lecture Series
ATLS: Initial Assessment and Management SAUSHEC Medical Student Lecture Series Objectives Identify sequence of priorities in assessing the multiply injured patient Apply principles outlined in primary
3. D Objective: Chapter 4, Objective 4 Page: 79 Rationale: A carbon dioxide level below 35 mmhg indicates hyperventilation.
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
APPROACH TO TRAUMA. Dr E.Memary Anesthesiologist Assistant Professor of SBMU
APPROACH TO TRAUMA Dr E.Memary Anesthesiologist Assistant Professor of SBMU Objectives Describe the initial approach to the injured patient, including the primary and secondary surveys. Identify the types
ITLS Pediatric Provider Course Advanced Pre-Test
ITLS Pediatric Provider Course Advanced Pre-Test 1. You arrive at the scene of a motor vehicle crash and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials
Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials 1 1. A high-risk bodily fluid for spreading infection is blood. 2. Items that can reduce the spread of infection include masks, gloves, and
PRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT
PRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT Board Approved June 2007 Revised December 2009 Revised July 2011 Revised June 2015 435 Hunter Street Fredericksburg, VA 22401
1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D.
1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D. Sacral-coccygeal 2. A 36-year-old male sustains blunt force thoracic
Restore adequate respiratory and circulatory conditions. Reduce pain
Pre-hospital management of the trauma patient is best performed by an integrated team focused on minimizing the time from injury to definitive care at an appropriate trauma center. Dispatchers, first responders,
HeartCode PALS. PALS Actions Overview > Legend. Contents
HeartCode PALS PALS Actions Overview > Legend Action buttons (round buttons) Clicking a round button initiates an action. Clicking this button, for example, checks the child s carotid pulse. Menu buttons
Standardize comprehensive care of the patient with severe traumatic brain injury
Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma
Emergency Room Resuscitation of the Unstable Trauma Patient
Emergency Room Resuscitation of the Unstable Trauma Patient Goals of trauma resuscitation Maintain: Systemic oxygenation Systemic perfusion Neurologic function Approach to unstable trauma patient Primary
Basic Assessment and Treatment of Trauma
Basic Assessment and Treatment of Trauma Final Exam Version 1 1. In which of the following scenarios would the potential for serious injury or death be the GREATEST? A. 77-kg (170-lb) man who falls 1.2
10. Severe traumatic brain injury also see flow chart Appendix 5
10. Severe traumatic brain injury also see flow chart Appendix 5 Introduction Severe traumatic brain injury (TBI) is the leading cause of death in children in the UK, accounting for 15% of deaths in 1-15
Head injuries. Severity of head injuries
Head injuries ED Teaching day 23 rd October Severity of head injuries Minor GCS 14-15 Must not have any of the following: Amnesia 10min Neurological sign or symptom Skull fracture (clinically or radiologically)
Advanced Assessment and Treatment of Trauma
Advanced Assessment and Treatment of Trauma Final Exam Version 1 1. In which of the following scenarios would the potential for serious injury or death be the GREATEST? A. 77-kg (170-lb) man who falls
The Primary Survey. Clay Cothren Burlew, MD FACS
The Primary Survey Clay Cothren Burlew, MD FACS Director, Surgical Intensive Care Unit Attending Surgeon, Denver Health Medical Center Associate Professor of Surgery, University of Colorado Outlining the
The Primary Survey. C. Clay Cothren, MD FACS. Attending Surgeon, Denver Health Medical Center Assistant Professor of Surgery, University of Colorado
The Primary Survey C. Clay Cothren, MD FACS Attending Surgeon, Denver Health Medical Center Assistant Professor of Surgery, University of Colorado Outlining the ABCs Why do we need such an approach? The
Major Trauma Scenarios. Ballarat Health Services Emergency Medicine Training Hub
Major Trauma Scenarios Ballarat Health Services Emergency Medicine Training Hub Trauma Scenario 1 You receive a phone call from the ambulance service. They have a 27 yr old male involved in a MCA, he is
CHEST INJURY PULMONARY CONTUSION
CHEST INJURY PULMONARY CONTUSION Introduction Pulmonary contusion refers to blunt traumatic lung parenchymal injury which results in oedema and haemorrhaging into alveolar spaces. It may also result in
Pediatric Advanced Life Support
Pediatric Advanced Life Support Pediatric Chain of Survival Berg M D et al. Circulation 2010;122:S862-S875 Prevention Early cardiopulmonary resuscitation (CPR) Prompt access to the emergency response system
Shenandoah Co. Fire & Rescue. Injuries to. and Spine. December EMS Training Bill Streett Training Section Chief
Shenandoah Co. Fire & Rescue Injuries to the Head and Spine December EMS Training Bill Streett Training Section Chief C.E. Card Information BLS Providers 2 Cards / Provider Category 1 Course # Blank Topic#
1. Which of the following organs is contained in the retroperitoneal region of the abdomen? A. Stomach B. Liver C. Kidney D.
1. Which of the following organs is contained in the retroperitoneal region of the abdomen? A. Stomach B. Liver C. Kidney D. Uterus 2. What is Sellick's maneuver? A. A method allowing the rescuer to hold
ESCAMBIA COUNTY TRAUMA TRANSPORT
TRAUMA ALERT CRITERIA are established state mandated criteria. ADULT TRAUMA ALERT CRITERIA (Physical and anatomical characteristics of a person 16 years of age or older) Any 1 of the following: 1. Airway:
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH OFFICE OF EMERGENCY MEDICAL SERVICES Basic EMT Practical Examination Cardiac Arrest Management
Basic EMT Practical Examination 6.0 - Cardiac Arrest Management Station 1 RESUSCITATION & DEFIBRILLATION No Point WHILE FUNCTIONING AS FIRST RESCUER: Point 1. Verbalizes or takes body substance isolation
ITLS Pediatric Provider Course Basic Pre-Test
ITLS Pediatric Provider Course Basic Pre-Test 1. You arrive at the scene of a motor vehicle collision and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
Overview. Overview. Chapter 30. Injuries to the Head and Spine 9/11/2012. Review of the Nervous and Skeletal Systems. Devices for Immobilization
Chapter 30 Injuries to the Head and Spine Slide 1 Overview Review of the Nervous and Skeletal Systems The Nervous System The Skeletal System Devices for Immobilization Cervical Spine Short Backboards Long
ITLS Advanced Pre-Test Annotated Key 8 th Edition
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
Pediatric Trauma Practice. Guideline for Management of the Child in Shock. Background
Pediatric Trauma Practice Guideline for Management of the Child in Shock Background Guideline for Management Trauma is the leading cause of death in children and adolescents in the United States. Although
Emergency Care Progress Log
Emergency Care Progress Log For further details on the National Occupational Competencies for EMRs, please visit www.paramedic.ca. Check off each skill once successfully demonstrated the Instructor. All
CRITICAL CARE FOUNDATION POLYTRAUMA
CRITICAL CARE FOUNDATION Rungta Hospital, Malviya Nagar, Jaipur (Supported by Indian Society of Critical Care Medicine, Jaipur Chapter) MODULE 2 POLYTRAUMA Note : All rights reserved. No part of this module
oriented evaluation of your patient and establishing priorities of care based on existing and
1 Chapter 12: Patient Assessment in the Field 2 Patient assessment means conducting a - oriented evaluation of your patient and establishing priorities of care based on existing and potential threats to
TNP Teaching Station E Focus: Intubated Patient, Interpersonal Violence
TNP Teaching Station E Focus: Intubated Patient, Interpersonal Violence Objective Upon completion of this teaching station the learner will be able to: 1. demonstrate appropriate assessment for a hemodynamically
Introduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 31.1 Define key terms introduced in this chapter. Slides 13 15, 17, 19, 28 31.2 Describe the components and function of the nervous system and the anatomy
PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
The Management of Trauma. Trauma. Ways of Trauma Management. Why it s important 08/06/2012. RTC s account for most injuries. Injury is a disease
The Management of Trauma RTC s account for most injuries Followed by assaults, drownings, falls, burns Injury is a disease Trauma 400 350 300 Trimodal Distribution of Death Laceration : Brain Brainstem
Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours
Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours William D. Whetstone M.D. Clinical Professor UCSF Department of Emergency Medicine SFGH ED Center for Neuro-Critical Emergencies
Medical NREMT-PTE. NREMT Paramedic Trauma Exam.
Medical NREMT-PTE NREMT Paramedic Trauma Exam https://killexams.com/pass4sure/exam-detail/nremt-pte Question: 41 Which of the following most accurately describes the finding of jugular venous distension
CHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS
CHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS PRACTICAL STATIONS CHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS 1. CARDIAC ARREST MANAGEMENT 2. AIRWAY & RESPIRATORY MANAGEMENT 3. SPINAL IMMOBILIZATION
Patient Assessment. Chapter 8
Patient Assessment Chapter 8 Patient Assessment Scene size-up Initial assessment Focused history and physical exam Vital signs History Detailed physical exam Ongoing assessment Patient Assessment Process
Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of
Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of Washington Seattle Children s Hospital Objectives Define
Assessment of the Trauma Patient
CHAPTER 10 Assessment of the Trauma Patient Overall Assessment Scheme Scene Size-Up Initial Assessment Trauma Physical Exam Vital Signs & SAMPLE History Medical SAMPLE History Physical Exam & Vital Signs
Trauma CT Scanning Protocol
Northern Trauma Network Trauma CT Scanning Protocol Background Whole body CT (WBCT) has assumed a pivotal position in trauma management. UK trauma is typically described as blunt and blind i.e. blunt trauma
The ABC s of Chest Trauma
The ABC s of Chest Trauma J Bradley Pickhardt MD, FACS Providence St Patrick Hospital What s the Problem? 2/3 of trauma patients have chest trauma Responsible for 25% of all trauma deaths Most injuries
Resuscitation Checklist
Resuscitation Checklist Actions if multiple responders are on scene Is resuscitation appropriate? Conditions incompatible with life Advanced decision in place Based on the information available, the senior
Chapter 32. Objectives. Objectives 01/09/2013. Spinal Column and Spinal Cord Trauma
Chapter 32 Spinal Column and Spinal Cord Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1.
ATLS 10th ed. Course Structure and Content Changes. Current Update on ATLS For Trauma Patients
ATLS 10th ed. Course Structure and Content Changes Current Update on ATLS For Trauma Patients ATLS 10th ed. Course Structure and Content Changes International ATLS 86 countries > 1 million trained > 50%
Aurora Health Care EMS Continuing Education Spring 2011 Packet THORACIC TRAUMA THE PREHOSPITAL APPROACH TO CHEST INJURY MANAGEMENT
Aurora Health Care EMS Continuing Education Spring 2011 Packet THORACIC TRAUMA Chest injuries are significant contributors to death from major trauma and can be difficult to assess adequately in the pre-hospital
Chapter 13. Objectives. Objectives 01/09/2013. Patient Assessment
Chapter 13 Patient Assessment Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms
TRAUMA PATIENT ASSESSMENT
SECTION: Adult Trauma Emergencies PROTOCOL TITLE: Injury General Trauma Management REVISED: 06/2015 OVERVIEW Each year, one out of three Americans sustains a traumatic injury. Trauma is a major cause of
PEDIATRIC TRAUMA EMERGENCIES
PEDIATRIC TRAUMA EMERGENCIES Last Revised: January 2015 1 PEDIATRIC COMA SCALE Indicator Eye Opening Spontaneous 4 To verbal stimuli 3 To pain only 2 No response 1 Verbal Response Oriented, appropriate
PRE-HOSPITAL EMERGENCY CARE COURSE.
PRE-HOSPITAL EMERGENCY CARE COURSE www.basics.org.uk Chest Assessment & Management BASICS Education March 2016 Objectives To understand the importance of oxygenation and ventilation To be able to describe
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
Chapter 30 Putting It All Together for the Trauma Patient
Chapter 30 Putting It All Together for the Trauma Patient Putting It All Together Balance need for prompt transport vs. treatment on scene. Select critical interventions to implement at scene of multipletrauma
Management of Severe Traumatic Brain Injury
Guideline for North Bristol Trust Management of Severe Traumatic Brain Injury This guideline describes the following: Initial assessment and management of the patient with head injury Indications for CT
Student Guide Module 4: Pediatric Trauma
Student Guide Module 4: Pediatric Trauma Problem based learning exercise objectives Understand how to manage traumatic injuries in mass casualty events. Discuss the features and the approach to pediatric
Initial Assessment and Management of the Trauma Patient
Initial Assessment and Management of the Trauma Patient 1 Epidemiology Road Traffic Accidents are major cause of long term morbidity and mortality in developing nations WHO predicts that by 2020, Road
SPINE EVALUATION AND CLEARANCE Basic Principles
SPINE EVALUATION AND CLEARANCE Basic Principles General 1. Entire spine is immobilized during primary survey. 2. Radiographic clearance of the spine is not required before emergent surgical procedures.
Pediatric Aspects of Advanced Trauma Life Support: Transition from EMS to the Trauma Room PEDIATRIC TRAUMA DIRECTOR, HASBRO CHILDREN S HOSPITAL
Pediatric Aspects of Advanced Trauma Life Support: Transition from EMS to the Trauma Room HALE WILLS, MD PEDIATRIC TRAUMA DIRECTOR, HASBRO CHILDREN S HOSPITAL Objectives 1. Identify the critical components
Trauma is a Disease Lets Get it Right A Good Trauma Examination Gives Your Patient Increased Odds for a Good Outcome
A Good Trauma Examination Gives Your Patient Increased Odds for a Good Outcome druffol@lumc.edu 708.216.4541 Lets Get it Right Trauma is a Disease Importance of Trauma Care and the trauma provider role
TRAUMA CHART. SW London & Surrey Trauma Network Trauma Documentation. Trauma Team. Pre-alert details
SW London & Surrey Trauma Network Trauma Documentation Pre-alert details Ambulance Call Sign: Age: Mechanism: Injury: Date: Call received by: Male / Female Time: St George s Hospital East Surrey Hospital
Purpose This Operating Procedure provides guidance on the management of blunt thoracic traumatic injury
Blunt Thoracic Trauma HELI.CLI.09 Purpose This Operating Procedure provides guidance on the management of blunt thoracic traumatic injury Procedure Management of Blunt Thoracic Traumatic Injury For Review
Hypotension / Shock. Adult Medical Section Protocols. Protocol 30
Hypotension / Shock History Blood loss - vaginal or gastrointestinal bleeding, AAA, ectopic Fluid loss - vomiting, diarrhea, fever nfection Cardiac ischemia (M, CHF) Medications Allergic reaction regnancy
PEDIATRIC TRAUMA: Implications for Respiratory Care
PEDIATRIC TRAUMA: Implications for Respiratory Care 17 th Annual Rainbow Respiratory Conference - September 4, 2015 Mike Dingeldein, MD Pediatric Surgeon Pediatric Trauma Medical Director Disclosures none
In accordance with protocols, this patient should be transported to which medical facility?
NOTE: Please select the most appropriate answer based on the Westchester Regional On-Line Medical Control Physician (OLMC) Regional System Overview, as well as current regional and state EMS protocols
Pediatric Shock. Hypovolemia. Sepsis. Most common cause of pediatric shock Small blood volumes (80cc/kg)
Critical Concepts: Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock - Same causes/different frequencies Pediatric Shock Hypovolemia Most
Prehospital Resuscitation for the 21 st Century Simulation Case. VF/Asystole
Prehospital Resuscitation for the 21 st Century Simulation Case VF/Asystole Case History 1 (hypovolemic cardiac arrest secondary to massive upper GI bleed) 56 year-old male patient who fainted in the presence
INTERNATIONAL TRAUMA LIFE SUPPORT
INTERNATIONAL TRAUMA LIFE SUPPORT NC ITLS Rev. 2/18 STUDENT GUIDE TO INTERNATIONAL TRAUMA LIFE SUPPORT What to wear ITLS is a practical course that stresses hands-on teaching. You should wear comfortable
Competency Log Professional Responder Courses
Competency Log Professional Responder Courses Check off each competency once successfully demonstrated. This log may be used as a support tool when teaching a Professional Responder course. Refer to the
MEDICAL CONTROL POLICY STATEMENT/ADVISORY. Re: Spinal Injury Assessment & Spinal Precautions Procedure
MEDICAL CONTROL POLICY STATEMENT/ADVISORY No. 2015-01 Date: January 20, 2015 Re: Spinal Injury Assessment & Spinal Precautions Procedure Office of the Medical Director Noel Wagner, MD, NREMT-P 1000 Houghton
Injuries to the Head and Spine
Injuries to the Head and Spine Anatomy Review Skull Protects the brain Made up of several bones with seam like sutures Regions of the scalp-frontal, occipital, parietal, temporal Bones of face Orbits Mandible
2017 Northern Mine Rescue Contest Written Exam (First Aid Competition)
2017 Northern Mine Rescue Contest Written Exam (First Aid Competition) 2017 2010 June 5, 2017 Findley Lake, New York 2017 Northern Mine Rescue Contest Written Exam First Aid Competition Directions: Fill
Focused History and Physical Examination of the
Henry: EMT Prehospital Care, Revised 3 rd Edition Lecture Notes Chapter 10: Focused History and Physical Examination of Trauma Patients Chapter 10 Focused History and Physical Examination of the Trauma
IFT1 Interfacility Transfer of STEMI Patients. IFT2 Interfacility Transfer of Intubated Patients. IFT3 Interfacility Transfer of Stroke Patients
IFT1 Interfacility Transfer of STEMI Patients IFT2 Interfacility Transfer of Intubated Patients IFT3 Interfacility Transfer of Stroke Patients Interfacility Transfer Guidelines IFT 1 TRANSFER INTERFACILITY
Pretest. Comprehensive Advanced Life Support: Provider Course
Pretest Comprehensive Advanced Life Support: Provider Course Please, use the answer sheet provided to record your answers and bring the completed answer sheet to class. Answer sheets will be collected
Chapter 26 Head and Spine Trauma The Nervous System The nervous system controls virtually all of our body activities including reflex, voluntary and
1 2 3 4 5 Chapter 26 Head and Spine Trauma The Nervous System The nervous system controls virtually all of our body activities including reflex, voluntary and involuntary activities Voluntary activities
Routine Patient Care Guidelines - Adult
Routine Patient Care Guidelines - Adult All levels of provider will complete an initial & focused assessment on every patient, and as standing order, use necessary and appropriate skills and procedures
SEMINOLE COUNTY EMS PROVISIONAL EMT SKILLS VERIFICATION
The following individual has completed the Seminole County EMS Provisional EMT Skills Verification check in the following areas: Oxygen, Airway and Ventilation Skills ALS Assistance Trauma Management Medical
Burn Priorities of Care: Triage/Treatment/Transfer. Via Christi Regional Burn Center Sarah Fischer, MSN, RN
Burn Priorities of Care: Triage/Treatment/Transfer Via Christi Regional Burn Center Sarah Fischer, MSN, RN Disclosure I have nothing to disclose Objectives Identify American Burn Association referral criteria
EMS System for Metropolitan Oklahoma City and Tulsa 2019 Medical Control Board Treatment Protocols
EMERGENCY MEDICAL RESPONDER EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC 14G PATIENT PRIORITIZATION While each patient will receive the best possible EMS care in a humane and ethical manner, proper patient
Emergency First Response (EFR) Skills Assessment Sheets V4 June 2017
Emergency First Response () Skills Assessment Sheets V4 June 2017 Airway management & ventilation Airway management & ventilation Trauma jaw thrust 1 Hand positions 2 Perform jaw thrust / mouth open 3
Portage County EMS Patient Care Guidelines. Routine Trauma Care
Portage County EMS Patient Care Guidelines Routine Trauma Care Priorities Chief Complaint LOPQRST AS/PN AMPL Initial Exam Rapid Trauma Assessment Detailed Focused Exam Data Goals of Therapy Monitoring
Kathryn Nuss, MD Associate Trauma Medical Director Associate Director, Emergency Medicine
Running on Empty Kathryn Nuss, MD Associate Trauma Medical Director Associate Director, Emergency Medicine Nationwide id Children s Hospital Associate Professor, Department of Pediatrics The Ohio State
Pain & Sedation Management in PICU. Marut Chantra, M.D.
Pain & Sedation Management in PICU Marut Chantra, M.D. Pain Diseases Trauma Procedures Rogers Textbook of Pediatric Intensive Care, 5 th ed, 2015 Emotional Distress Separation from parents Unfamiliar
Shock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
Pediatric Trauma Care
2013 Standard Trauma Care Procedures (Pediatric) Traumatic injuries require prompt care and transportation. Always suspect cervical injury. Note the mechanism of injury and any other condition that may
The assessment helps decide if the patient is an emergency, priority or non-urgent case.
Emergency Triage Assessment and Treatment The World Health Organisation (WHO) has produced some useful guidelines about how to improve the care of our patients and their survival in hospital. This is a
Please wear comfortable clothing and closed-toed shoes as you will do hands-on skills practice outside.
Dear PHTLS Student: Welcome to the Prehospital Trauma Life Support Program sponsored by the National Association of EMT s and hosted by the UCLA Center for Prehospital Care! The PHTLS program was created
It s as easy as ABC. Dr Andrew Smith
It s as easy as ABC Dr Andrew Smith ABCDE A simple method to apply to your assessment of patients. It is a good failsafe in all situations i.e. At an end of an OSCE when you re put under pressure! Correct
MODULE IV. Pediatric Trauma
MODULE IV Pediatric Trauma PRE-HOSPITAL HIGH RISK CRITERIA Blunt injury Significant injury; physiologic compromise Penetrating injuries Thorax, abdomen, head and neck High risk burns: > 10% second degree
Introduction to Advanced Trauma Life Support ATLS
Introduction to Advanced Trauma Life Support ATLS Objectives Concepts of primary & secondary survey Priorities & Life threatening conditions Clinical & Surgical skills Basic knowledge Rapid assessment
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it.
Author(s): Tim Maxim, BA, RN, 2011 License: 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/
Canadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet
Canadian Trauma Trials Collaborative STUDY CENTRE: Institution: City / Province: / Occult Pneumothorax in Critical Care (OPTICC): Standardized Sheet PATIENT DEMOGRAPHICS: First Name: Health record number
Pre-hospital Response to Trauma and Brain Injury. Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center
Pre-hospital Response to Trauma and Brain Injury Hans Notenboom, M.D. Asst. Medical Director Sacred Heart Medical Center Traumatic Brain Injury is Common 235,000 Americans hospitalized for non-fatal TBI
FIRST AID WRITTEN EXAM. Team Name: 1. Participation in a critical incident stress debriefing (CISD) is mandatory. a. TRUE b. FALSE
2015 NEW IBERIA MINE RESCUE CONTEST FIRST AID WRITTEN EXAM Name: Date: 1. Participation in a critical incident stress debriefing (CISD) is mandatory. 2. The use of accessory muscles in the chest, abdomen
Yaniv Berliner EMS STABILIZATION
Yaniv Berliner EMS STABILIZATION Scene survey EMS must first evaluate the safety of the scene. Downed power lines, fire, traffic Is there a need for specialized equipment for extrication. Is there a need
Shock. Perfusion. The cardiovascular system s circulation of blood and oxygen to all the cells in different tissues and organs of the body
Shock Chapter 10 Shock State of collapse and failure of the cardiovascular system Leads to inadequate circulation Without adequate blood flow, cells cannot get rid of metabolic wastes The result- hypoperfusion