Trauma Teams & Management
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Transcript of Trauma Teams & Management
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Trauma Teams &Trauma Teams &
ManagementManagement
or the ABC of Traumaor the ABC of Trauma
Terry JongenTerry Jongen
Clinical Nurse SpecialistClinical Nurse Specialist
Emergency DeptEmergency DeptMarch 04March 04
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What is a trauma?What is a trauma?
Any injury or wound that requiresAny injury or wound that requiresintervention to aid recoveryintervention to aid recovery Major & MinorMajor & Minor
Major ISS 16+Major ISS 16+ Minor uncomplicatedMinor uncomplicated-- single organ / limbsingle organ / limb
RPHRPH MajorsMajors 400 pa400 pa
MinorsMinors 3500 pa3500 pa
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Trauma ResponseTrauma Response
NotificationNotification St John AmbulanceSt John Ambulance-- radio / phoneradio / phone
RFDS phoneRFDS phone
Occasionally just turning up and ringing theOccasionally just turning up and ringing the
door belldoor bell
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Set UpSet Up Form a Trauma TeamForm a Trauma Team
Airway Doctor & NurseAirway Doctor & Nurse (may be nurse 3 as well)(may be nurse 3 as well)
Doctor 2 & Nurse 2Doctor 2 & Nurse 2
Doctor 3 & Nurse 3Doctor 3 & Nurse 3
Team Leader Doctor & NurseTeam Leader Doctor & Nurse
PCA (gopher)PCA (gopher)
Radiographer x2Radiographer x2
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Set UpSet Up
ResusResus Cover existing patientsCover existing patients
Airway equipmentAirway equipment
FluidsFluids
DrugsDrugs
EquipmentEquipment
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On ArrivalOn ArrivalTrauma Team CriteriaTrauma Team Criteria
HistoryHistory MechanismMechanism
MBA >30kphMBA >30kph MVA >60kphMVA >60kph Fall >3mFall >3m
PedestrianPedestrian Death in same accidentDeath in same accident EjectionEjection No Seat beltNo Seat belt
CyclistCyclist Roll overRoll over PenetratingPenetrating Ejection/extricationEjection/extrication
InjuriesInjuries
Crush injuryCrush injury 2 or more limbs broken2 or more limbs broken 2 or more body parts2 or more body parts
Spinal painSpinal pain Burns >15%Burns >15% Penetration of torsoPenetration of torso
HaemodynamicsHaemodynamics
BP
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AirwayAirway Response talking?Response talking?
Clear & open airwayClear & open airway SuctionSuction
PositionPosition
Oxygen 100% NRBOxygen 100% NRB IntubationIntubation
Surgical airwaySurgical airway Protect cervical spineProtect cervical spine
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BreathingBreathing
QuantityQuantity QualityQuality Sounds & fieldsSounds & fields
Accessory musclesAccessory muscles SupplementSupplement
BaggingBagging
Oxy logOxy log
Find any problemsFind any problems correct themcorrect them
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CirculationCirculation
Two wide bore IV cannulas 14 g or betterTwo wide bore IV cannulas 14 g or better FluidsFluids 11 litrelitre crystalloidscrystalloids
500ml colloid500ml colloid
Uncross matched bloodUncross matched blood
Collect blood (grouping & x match)Collect blood (grouping & x match)
MastMast Bandage bleedingBandage bleeding Control fracturesControl fractures
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Remember the ABC is the primaryRemember the ABC is the primaryassessmentassessment
Identifies life threats that requireIdentifies life threats that requireimmediate correctionimmediate correction
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E= ExposureE= Exposure Put the whole patient on displayPut the whole patient on display
Cut of clothing if requiredCut of clothing if required
F= FreezingF= Freezing
Keep warmKeep warm Cover and recoverCover and recover
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G= Get Vital signsG= Get Vital signs Full observationsFull observations
TPR & BP, NVO, GCSTPR & BP, NVO, GCS Bloods, BSL,Bloods, BSL, haemoquehaemoque
ECGECG
TV, Air pressure OTV, Air pressure O22 SatsSats. FiO. FiO22 Pain scorePain score
AMPLEAMPLE
?tetanus status?tetanus status Forensic evidence protectionForensic evidence protection
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H= Head to Toe assessmentH= Head to Toe assessment Systematic assessment of whole patientSystematic assessment of whole patient
Identifying other or new injuriesIdentifying other or new injuries
Log roll & PR (remember the rule)Log roll & PR (remember the rule)
Followed by a focused assessmentFollowed by a focused assessment
Commencement of treatmentsCommencement of treatments Splint fracturesSplint fractures
Dressings / suturingDressings / suturing
IDCIDC
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MeanwhileMeanwhile
Radiographers are shooting a traumaRadiographers are shooting a traumaseries of xseries of x--raysrays
Continuous reassessment of vital signsContinuous reassessment of vital signs
Calling in consultsCalling in consults
Expanded drug regimeExpanded drug regime
Gastro viewGastro view
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Other diagnosticsOther diagnostics DPLDPL CTCT
Interventional radiologyInterventional radiology
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Scary StuffScary Stuff
ThoracotomyThoracotomy Only good forOnly good for
penetrating trauma orpenetrating trauma or
controllingcontrolling abdoabdo
bleedingbleeding Cross clamp aortaCross clamp aorta
Fix holesFix holes
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More Scary StuffMore Scary Stuff
Penetrating woundsPenetrating wounds
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BurnsBurns
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Limb injuriesLimb injuries
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Interesting practicesInteresting practices
Hypotensive managementHypotensive management Some evidence that maintaining a BP 85 to 90Some evidence that maintaining a BP 85 to 90systolic has improved outcomessystolic has improved outcomes
Needs farther researchNeeds farther research Use of Clotting factorsUse of Clotting factors
Factor 7aFactor 7a
Early use of platelets & FFPEarly use of platelets & FFP
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Be awareBe aware
Shock is not just low BP and elevatedShock is not just low BP and elevatedpulsepulse
Subtle signs more importantSubtle signs more important
High index of suspicionHigh index of suspicion
Stick to the planStick to the plan
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Major Incident ResponseMajor Incident Response
West Health PlanWest Health Plan Based on MIMMS approachBased on MIMMS approach Medical Teams from the hospitalsMedical Teams from the hospitals
Single retrievalsSingle retrievals entrapmententrapment