Emergency Medicine – Trauma: What You Need to Know Whiteboard Animation Transcript with Kaushal Shah, MD

Total Page：16

File Type：pdf, Size：1020Kb

Emergency Medicine – Trauma: What You Need to Know Whiteboard Animation Transcript with Kaushal Shah, MD Trauma comes in two basic varieties: blunt trauma and penetrating trauma. Nonetheless, major trauma patients should always be approached the same way: primary survey followed by a secondary survey. Don’t let the blood and gore distract you. The primary survey entails a systematic assessment using ABCDE in order to identify the true life-threatening injuries and initiate resuscitation. Then a detailed head-to-toe exam should occur, which we call the secondary survey. A. Airway assessment. If blood, vomit or the patient’s own saliva is blocking the airway (which often occurs in unconscious patients), they will need suctioning and possibly intubation. B. Breathing. Examine the chest through inspection, auscultation, and palpation. You are looking for life-threatening injuries. Decreased breath sounds, subcutaneous emphysema, broken ribs, and tracheal deviation, are concerning for a tension pneumothorax, hemothorax, pulmonary contusions, flail chest, and cardiac tamponade. C. Circulation. If the patient has a fast heart rate or low blood pressure, suspect ongoing hemorrhage or blood loss, the number one cause of preventable death in trauma. Bleeding is likely in one of four locations: chest, abdomen, pelvis, or fractured long bones. Start IV fluids or blood transfusion through two big intravenous lines. D. Disability. A basic neurologic assessment will help you calculate a GCS or Glasgow Coma Scale. It evaluates Eye Opening, Verbal Response, and Motor Response that is universally understood on a 15-point scale. E. Exposure. The patient should be completely undressed to look for all injuries. Along with the secondary survey, the major trauma patient often requires a chest x-ray, pelvis x- ray, and an ultrasound of the abdomen called a FAST (focused assessment with sonography in trauma). This will allow identiﬁcation of blood loss from the most common sources. If blood loss exceeds the resuscitation with fluid and blood, the patient will spiral into the classic trauma triad of death: acidosis, coagulopathy, and hypothermia. 1.

Copy Link

Recommended publications

Effect of Hypothermia on Haemostasis and Bleeding Risk: a Narrative Review
Review Journal of International Medical Research 2019, Vol. 47(8) 3559–3568 Effect of hypothermia on ! The Author(s) 2019 Article reuse guidelines: haemostasis and bleeding sagepub.com/journals-permissions DOI: 10.1177/0300060519861469 risk: a narrative review journals.sagepub.com/home/imr Thomas Kander and Ulf Schott€ Abstract It must be remembered that clinically important haemostasis occurs in vivo and not in a tube, and that variables such as the number of bleeding events and bleeding volume are more robust measures of bleeding risk than the results of analyses. In this narrative review, we highlight trauma, surgery, and mild induced hypothermia as three clinically important situations in which the effects of hypothermia on haemostasis are important. In observational studies of trauma, hypothermia (body temperature <35C) has demonstrated an association with mortality and morbidity, perhaps owing to its effect on haemostatic functions. Randomised trials have shown that hypothermia causes increased bleeding during surgery. Although causality between hypothermia and bleeding risk has not been well established, there is a clear association between hypothermia and negative outcomes in connection with trauma, surgery, and accidental hypothermia; thus, it is crucial to rewarm patients in these clinical sit- uations without delay. Mild induced hypothermia to 33C for 24 hours does not seem to be associated with either decreased total haemostasis or increased bleeding risk. Keywords Hypothermia, coagulopathy, haemostasis, bleeding, trauma, surgery, injury Date received: 20 March 2019; accepted: 13 June 2019 Introduction Many studies have been conducted to inves- Lund University, Ska˚ne University Hospital, Department tigate the effects of hypothermia on haemo- of Clinical Sciences Lund, Intensive and Perioperative stasis, and these have yielded contradictory Care, Lund, Sweden results.
[Show full text]
EDUCATION STANDARDS Tabe of Contents
2020 NATIONAL EMERGENCY MEDICAL SERVICES EDUCATION STANDARDS Tabe of Contents Executive Summary 4 Pathophysiology X Introduction X Life Span Development X Historical Development of EMS in the United States X The National EMS Education Standards X Public Health X Description, Explanation, and Rationale Related to the Update X Pharmacology X 2019 National EMS Scope of Practice Model Relationship X Principles of Pharmacology X NREMT Practice Analysis X Medication Administration X Domains of EMS: Learning, Competency, Authorization, and X Emergency Medications X Operational/Local Qualification X Education Standards vs. Instructional Guidelines vs. Curriculum X Airway Management, Respirations and Artificial Ventilation X What Are the Instructional Guidelines: X Airway Management X Beyond the Scope of the Project X Respiration X Degree Requirements X Artificial Ventilation X AEMT Accreditation X Portable Technologies X Assessment X Instructional Practices: X Scene Size-Up X Interprofessional Education, Simulation, Shadowing X Primary Assessment X Team Composition X History Taking X Sequence of Instruction X Secondary Assessment X Locally Identified Topics X Monitoring Devices X Implicit Expectations X Reassessment X Resource Documents/Appendix X Evidence Based Guidelines – NASEMSO Clinical Guidelines X Medicine X Education Standards with Noteworthy Adjustment X Medical Overview X Neurology X National EMS Education Standards X Abdominal and Gastrointestinal Disorders X Preparatory X Immunology X EMS Systems X Infectious Diseases X Research X
[Show full text]
Staged Abdominal Re-Operation for Abdominal Trauma
TJTES Ulus Travma Derg. 2003 Jul;9(3):149-153 TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY STAGED ABDOMINAL RE-OPERATION FOR ABDOMINAL TRAUMA Korhan TAVILOGLU, MD, FACS ABSTRACT Background: To review the current developments in staged abdominal re-operation for abdominal trauma. Methods: To overview the steps of damage control laparotomy. Results: The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. Conclusions: General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity. Key words: abdominal trauma, staged laparotomy, abdominal compartment syndrome, damage control surgery INTRODUCTION Feliciano et al.12 reported the survival in nine of ten During the past decade, a new surgical patients who underwent temporary laparotomy approach to patients with devastating trauma has with pad tamponade for hepatic injuries. In the emerged. Based on a modified operative beginning of the 1980’s, two studies reported sequence using rapid lifesaving techniques, abdominal packing followed by rapid abdominal definitive resection and reconstruction are closure that was used for treatment of delayed until the patient can be adequately coagulopathy of nonhepatic abdominal injuries. resuscitated and stabilized in the surgical intensive care unit.1-5 WHAT IS STAR? Damage control is currently the most common STAR is a technique of serial
[Show full text]
Chapter 1 - Trauma Team from Prehospital Through the Emergency Department Test Questions
Chapter 1 - Trauma Team from Prehospital through the Emergency Department Test Questions 1. As the prehospital provider approaches the scene of a trauma call, they perform a. a radio transmission to the hospital b. a scene size up c. an estimate of neck size for c-collar d. an estimate of victim’s height and weight 2. Field intubation has been proven to improve outcome in a. patients with BP less than 90 mm Hg b. patients with GCS less than 9 c. patients with acute respiratory distress d. none of the above 3. A proven technique of hemorrhage control is a. Direct pressure b. Elevate above the heart c. Pressure points d. Cold application 4. Prehospital care for apparent pelvic fractures includes a. DO NOT ROCK or palpate the pelvis in the prehospital arena b. Avoid log rolling as much as possible c. Apply splint if in your area protocols d. All of the above 5. Most preventable deaths in trauma care are due to a. Delay in CPR b. Cardiac tamponade c. Airway obstruction d. Tension pneumothorax STN 2012 Electronic Library: Chapter 1 - Trauma Team from Prehospital Through the Emergency Department Test Questions 2 6. For resuscitation to occur, there must be a. Cellular perfusion and tissue oxygenation b. Restoration of a blood pressure greater than 90mm Hg c. A hemoglobin greater than 9g/dL d. A PaO2 greater than 80 mm Hg 7. The Trauma Triad of Death is a. Hypotension, tachycardia and decreased urine output b. Infection, inadequate nutrition, DVT’s c. Hypothermia, acidosis and coagulopathy d.
[Show full text]
General Approach to Traumatic Injuries
Cambridge University Press 978-1-108-45028-7 — The Emergency Medicine Trauma Handbook Edited by Alex Koyfman , Brit Long Excerpt More Information Chapter General Approach to 1 Traumatic Injuries Ryan O’Halloran and Kaushal Shah Introduction Trauma is the fourth leading cause of death overall in the United States and the number one cause of death for ages 1 to 44 – second only to heart disease and cancer in those older than 45 (CDC).1 As the disease burden from infectious diseases declines and secondary preven- tion of chronic conditions improves, the relative importance of the practice of trauma care becomes even more apparent. Though safety engineering has improved across many indus- tries (one need only consider examples such as crosswalk and bike lane planning, football helmet technology, and motor vehicle computerized improvements), trauma remains a significant threat to life and limb in emergency medicine. The Trauma Team The American College of Surgeons, the governing body for credentialing trauma centers, has provided guidelines for optimal resources necessary for a coordinated response to a critically injured trauma patient. Box 1.1 demonstrates the players suggested for an optimal response. While response teams may vary, several principles are key to the functioning of a good, interdisciplinary team. These include clearly establishing roles for members of the team, following policy and protocols established in advance, briefing prior to the arrival of the patient, and debriefing after the event, whether immediately after the event
[Show full text]
Zone 1 Vascular Abdominal Trauma. Damage Control and Staged Management
Review Article Clinics in Surgery Published: 12 Feb, 2018 Zone 1 Vascular Abdominal Trauma. Damage Control and Staged Management Ioannis Stamatatos1*, Marigo Theodorou2, Efstathios Metaxas3, Dimitrios Klapsakis4, Konstantinos Bouboulis2,3, Nikolaos Tzatzadakis3 and Athanasios Rogdakis2 1Department of Vascular and Endovascular Surgery, General Hospital Nikaia, Greece 2Department of General Surgery, General Hospital Nikaia, Greece 3Department of Cardiothoracic Surgery, General Hospital Nikaia, Greece 4Department of Orthopaedics and Trauma, General Hospital Nikaia, Greece Abstract Vascular abdominal injuries of major vessels in zone 1 abdominal cavity are the most common cause of death after penetrating abdominal trauma. Abdominal arterial and vein injuries occur with the same incidence. Patients with retroperitoneal vascular injury and intact retroperitoneum may present hemodynamically stable due to tamponade. The main goal of staged approach is to control any major haemorrhage into the abdomen until the patient is hemodynamically stabilized in the ICU and reconstruction can be done in final reoperation. Multidisciplinary management is imperative to prevent the “lethal triad” and assures the best optimal outcome for these critically wounded patients. Introduction Abdominal vascular injuries are the most common cause of death after penetrating abdominal trauma. Blunt injuries to major abdominal vessels are rare. Major injuries to large vessels in the abdominal zone 1 usually cause significant hemoperitoneum and shock. The type of clinical presentation varies widely and depends on the presence of retroperitoneal tamponade. Patients with an intact retroperitoneum may be hemodynamically stable on presentation but when the OPEN ACCESS retroperitoneum tamponade is lost, signs of shock and acute hypovolemia are present. Many patients with major abdominal vascular injuries require massive blood transfusions, are hypotensive, *Correspondence: and become severely hypothermic, acidotic, and coagulopathic intra operatively.
[Show full text]
Autologous Transfusion of Shed Pleural Blood in Trauma - a Register Study to Determine Applicability
Sahlgrenska academy Autologous transfusion of shed pleural blood in trauma - a register study to determine applicability Degree Project in Medicine Henrik Örtenwall Programme in Medicine, The Sahlgrenska Academy Gothenburg, Sweden, 2021 Supervisors: Dr. Ragnar Ang, trauma surgeon, SU Doc. Jenny Skytte-Larsson, anesthesiologist, FömedC Table of contents Abbreviations ............................................................................................................................. 3 Abstract ...................................................................................................................................... 4 Introduction ................................................................................................................................ 5 Aim ............................................................................................................................................. 6 Background ................................................................................................................................ 6 History ................................................................................................................................................. 6 Transfusion guidelines ........................................................................................................................ 9 Pros and cons of allogenic blood component transfusion ................................................................. 10 Pros and cons of autologous whole blood transfusion .....................................................................
[Show full text]
Monitoring the Coagulation Status of Trauma Patients with Viscoelastic Devices Yuichiro Sakamoto*, Hiroyuki Koami and Toru Miike
Sakamoto et al. Journal of Intensive Care (2017) 5:7 DOI 10.1186/s40560-016-0198-4 REVIEW Open Access Monitoring the coagulation status of trauma patients with viscoelastic devices Yuichiro Sakamoto*, Hiroyuki Koami and Toru Miike Abstract Coagulopathy is a physiological response to massive bleeding that frequently occurs after severe trauma and is an independent predictive factor for mortality. Therefore, it is very important to grasp the coagulation status of patients with severe trauma quickly and accurately in order to establish the therapeutic strategy. Judging from the description in the European guidelines, the importance of viscoelastic devices in understanding the disease condition of patients with traumatic coagulopathy has been widely recognized in Europe. In the USA, the ACS TQIP Massive Transfusion in Trauma Guidelines proposed by the American College of Surgeons in 2013 presented the test results obtained by the viscoelastic devices, TEG® 5000 and ROTEM®, as the standard for transfusion or injection of blood plasma, cryoprecipitate, platelet concentrate, or anti-fibrinolytic agents in the treatment strategy for traumatic coagulopathy and hemorrhagic shock. However, some studies have reported limitations of these viscoelastic devices. A review in the Cochrane Library published in 2015 pointed out the presence of biases in the abovementioned reports in trauma patients and the absence of a quality study in this field thus far. A quality study on the relationship between traumatic coagulopathy and viscoelastic devices is needed. Background of hemorrhagic shock that accounts for 90% of incidents Two of the major causes of coagulopathy in trauma of traumatic shock. Since coagulation abnormality which patients are coagulopathy secondary to hemorrhagic is a physiological response to massive bleeding frequently shock due to massive bleeding and coagulopathy due to occurs after severe trauma and is an independent pre- severe head injury [1].
[Show full text]
Trauma Care the Essential Clinical Skills for Nurses Series Focuses on Key Clinical Skills for Nurses and Other Health Professionals
Trauma Care The Essential Clinical Skills for Nurses series focuses on key clinical skills for nurses and other health professionals. These concise, accessible books assume no prior knowledge and focus on core clinical skills, clearly pre- senting common clinical procedures and their rationale, together with the essential background theory. Their user-friendly format makes them an indispensable guide to clinical practice for all nurses, especially to student nurses and newly qualiﬁ ed staff. Other titles in the Essential Clinical Skills for Nurses series: Central Venous Access Devices Leg Ulcer Management Lisa Dougherty Christine Moffatt, Ruth Martin ISBN: 9781405119528 and Rachael Smithdale ISBN: 9781405134767 Clinical Assessment and Monitoring in Children Practical Resuscitation Diana Fergusson Edited by Pam Moule and ISBN: 9781405133388 John Albarran ISBN: 9781405116688 Intravenous Therapy Theresa Finlay Pressure Area Care ISBN: 9780632064519 Edited by Karen Ousey ISBN: 9781405112253 Respiratory Care Caia Francis Infection Prevention and Control ISBN: 9781405117173 Christine Perry ISBN: 9781405140386 Care of the Neurological Patient Helen Iggulden Stoma Care ISBN: 9781405117166 Theresa Porrett and Anthony McGrath ECGs for Nurses ISBN: 9781405114073 Phil Jevon ISBN: 9780632058020 Caring for the Perioperative Patient Monitoring the Critically Paul Wicker and Joy O’Neill Ill Patient ISBN: 9781405128025 Second Edition Phil Jevon and Beverley Ewens Nursing Medical Emergency ISBN: 9781405144407 Patients Philip Jevon, Melanie Treating the Critically Ill Patient Humphreys and Beverley Ewens Phil Jevon ISBN: 9781405120555 ISBN: 9781405141727 Wound Management Pain Management Carol Dealey and Janice Cameron Eileen Mann and Eloise Carr ISBN: 9781405155410 ISBN: 9781405130714 Trauma Care Initial assessment and management in the emergency department Edited by Elaine Cole MSc, BSc, Pg Dip (ed), RGN A John Wiley & Sons, Ltd.
[Show full text]
Case Presetnation Trauma ACEP
Tricky Trauma: Cutting Edge Aeromedical Interventions In the Rural Setting Adam Goodcoff OMS-III1, L. Michael Peterson D.O.2 West Virginia School of Osteopathic Medicine - Lewisburg, WV1, HealthNet Aeromedical Services – Charleston, WV2 Introduction Differential Diagnoses / Problem List Management of trauma has evolved rapidly within the last 50 Severe / Emergent Moderate / Urgent Mild / Non-Emergent years. The ability to provide blood products, liquid never-frozen Abdominal Impalement Lower extremity crush Acute Kidney Injury plasma, and Plasma-Lyte through inline warmers has redefined injury pre-hospital trauma and critical care transport. This case was Hemorrhage in abdomen Rhabdomyolysis Hypocalcemia selected because these interventions play an especially uncontrolled significant role in rural areas where access to care is sparse and Hypovolemic Shock Hyperkalemia Wound Infection - consider transport, even by air, can be over an hour to the nearest trauma Clostridium Perfringens facility. Health Net Aeromedical (Charleston, WV) provides these given mechanism of injury services to rural West Virginia offering lifesaving care to many Metabolic Acidosis Hypothermia Prolonged limb ischemia without access. Discussion Trauma Resuscitation and Volume Repletion • With the use of prehospital plasma and blood, traumatic hemorrhage survival has become a reality1. The • Consider Plasma-Lyte or Lactated Ringer’s over NS when acid-base status is of transfusion of both blood and plasma was introduced concern and validated in the military setting and has become • As per protocols at Health Net Aeromedical, plasma and blood should be given common in civilian medicine2 resolving both volume and simultaneously if possible through an inline warmer. coagulopathy issues3. • If unable to establish two lines, plasma should be given first.
[Show full text]
Trauma Killers Objectives Case‐SCH
10/17/2019 Trauma Killers 1 Objectives • Recognize components of the trauma triad of death • Identify interventions to manage life threatening conditions • Relate mechanisms of injury to types of injuries sustained in trauma • State the goal of post resuscitation care • Identify post resuscitative care of the trauma patient • Articulate benefits of a tertiary exam • Understand the psychosocial impact of trauma 2 Case‐SCH ETC First Peak Third Peak • Seconds to minutes of injury • Days to months after injury – Irreversible brain injury – Why? – Exsanguination • Very few of these patients can be salvaged due to extent of injury Second Peak • Minutes to hours after injury ‐ Trauma Care focuses primarily on this peak – Major internal hemorrhages of head, resp. system, or Abd organs – Multiple minor injuries resulting in severe blood loss 3 1 10/17/2019 Trauma Triad of Death 4 Hemorrhage • Blood on the floor x 4 more – Obvious Bleeding – Chest • Holds up to 3L – Pelvis/Retro‐ peritoneum • 2.5 L – Thigh • 1‐2 L – Abdomen 5 Hypothermia • Body Temp of <95 F (35 C) • Approximately 2/3 of all bleeding trauma patients arrive in the emergency room with a core temp <96.8 F(36 C) • Affects every organ system 6 2 10/17/2019 Hypothermia: Contributing Factors • Environment – Outside temperature, prolonged extrication times, skin exposure, air movement, wet clothing • Extremes of Age – Very young or elderly • Drug/Alcohol Use • Injuries Sustained – Hemorrhage, TBI, Burns • Pre‐existing conditions – Hypoglycemia, hypothyroidism, diabetic neuropathy, Peripheral
[Show full text]
Outcomes of Damage Control Surgery for Abdominal Trauma Evaluated Using the Trauma and Injury Severity Score and Lethal Triad in a Single Institution
Hiroshima J. Med. Sci. 9 Vol. 69, No. 1, 9~14, March, 2020 HIMJ 69–2 Outcomes of Damage Control Surgery for Abdominal Trauma Evaluated Using the Trauma and Injury Severity Score and Lethal Triad in a Single Institution Ko OSHITA1), Hideki NAKAHARA1,*), Akihiko OSHITA1,2), Yasuhiro MATSUGU1), Takashi URUSHIHARA1,2), and Toshiyuki ITAMOTO1,2) 1) Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima 734-8530, Japan 2) Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan ABSTRACT In trauma management, damage control surgery is an effective approach to decrease the incidence of pre- ventable trauma death. In this study, we aimed to investigate the survival outcomes and clinical factors in patients undergoing damage control surgery for severe abdominal trauma, in relation to trauma severity based on the trauma and injury severity score and lethal triad (hypothermia, metabolic acidosis, and coagu- lopathy), to assess the indicators of mortality and criteria for performing damage control surgery. Fifteen patients with severe abdominal trauma underwent damage control surgery from January 2011 to September 2017. We compared the short-term outcomes and perioperative factors associated with the trauma and injury severity score and the lethal triad between survivors and non-survivors. Of the 15 included patients, eight (53.3%) survived and seven (46.7%) died. No preventable deaths occurred. The patient characteristics, including age, sex, and mechanism of injury were not related to survival. The injury severity score (p = 0.035) and abbreviated injury scale score of the head (p = 0.005) were significantly higher among the non- survivors than among the survivors.
[Show full text]