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General Radiography in the Critical Care and Trauma Environment
Published in Christopher M. Hayre, William A. S. Cox, General Radiography, 2020
Before considering any aspect of imaging patients who have experience either significant trauma or an acute condition it would be prudent to consider the ‘golden hour’. The golden hour is the idea that in cases of significant trauma (or a serious acute condition such as a stroke), a patient is likely to have significantly improved outcome where injuries and other issues are diagnosed and treatment started within approximately 60 minutes. After this time, the likelihood of patient mortality is believed to increase significantly. The golden hour is a somewhat contentious concept within emergency medicine and, in reality, there is limited and occasionally conflicting literature to support the idea itself (Rogers, Rittenhouse, & Gross, 2015).
The primary survey
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The primary survey should be conducted at the first safe opportunity. The immediate pre-hospital priority is always to ensure the safety of the rescuers, other persons present and the patient. If the initial environment is non-permissive, the primary survey may be abbreviated or delayed to allow rapid evacuation or securing of the area. If so, it should be repeated or completed as soon as possible. It should also be repeated if the patient’s condition alters significantly and at handovers of care. The term golden hour was an important one, designed to emphasise the importance of the trauma victim reaching definitive care within 60 minutes of injury. However, it is best avoided, as it risks introducing a degree of complacency into the assessment and evacuation process. The aim must be to evacuate the seriously or critically injured patient to the care they need to provide the best chance of survival at the earliest opportunity. The aim of the primary survey is to identify these patients and ensure that there is no unnecessary delay on scene, interventions being restricted to those needed immediately to save life.
Recognition and Management of the Sick Child
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julian Gaskin, Raymond W. Clarke, Claire Westrope
The way we approach recognizing and managing seriously ill patients nowadays has largely been shaped by the principles developed in Basic and Advanced Life Support courses (BLS and ALS).1,2 Courses and teaching modules focused on the needs of healthcare personnel looking after sick children developed from the early 1990s as the Advanced Paediatric Life Support (APLS) system, which teaches a structured and reproducible set of skills applicable across specialty, language, cultural and geographical boundaries.1 APLS teaching materials are produced and regularly updated by a multidisciplinary team of paediatric emergency physicians, anaesthetists, surgeons and paediatricians. Much emphasis is given to the care within the first hour, the so-called ‘golden hour’, which governs the trajectory of subsequent management. With important, easy-to-remember initial steps, the right order of resuscitation can begin to help avert a sick child deteriorating, or even worse, dying.
Activation and On-Scene Intervals for Severe Trauma EMS Interventions: An Analysis of the NEMSIS Database
Published in Prehospital Emergency Care, 2023
Nicolas W. Medrano, Cynthia Lizette Villarreal, N. Clay Mann, Michelle A. Price, Kurt B. Nolte, Ellen J. MacKenzie, Pam Bixby, Brian J. Eastridge
The first hour after traumatic injury is historically known as the “golden hour” and is the period of care following an injury in which rapid assessment and resuscitation are fundamental to survival (7). Though there is no true golden hour, the time lapse between injury and care is a critical element for patients with severe injury (8–12), with longer prehospital transport times likely contributing to higher mortality rates in more severely injured patients. This effect is more prominent among rural trauma patients than similarly injured urban patients (13–17). To substantiate this assertion, it has been demonstrated that states with poor trauma care access have more prehospital deaths, contributing to higher overall injury mortality (9). Because of the “access effect” on mortality and morbidity rates, having an accurate understanding of prehospital intervals is imperative to identifying geographic “trauma care deserts,” where there is decreased access to immediate care.
Training in polytrauma management in medical curricula: A scoping review
Published in Medical Teacher, 2020
PT is a modern medical term used in describing the medical condition of patients suffering from multiple severe traumatic injuries. To date, there is no internationally agreed definition of PT. The most recently updated definition suggests that trauma should include specific anatomical and physiological parameters to fit into the definition of PT. Anatomically, it is agreed that a patient with PT should have at least two body regions (systems) with Abbreviated Injury Scale (AIS) of more than two (Association for the Advancement of Automotive Medicine 2019). There is no international consensus on the physiological parameters of PT but it will most likely include tissue hypoxia and coagulopathy (Butcher and Balogh 2014). PT is a leading cause of morbidity and mortality in developed and developing countries (Matar 2007) and commonly affects young people within the 18–44 years age group (Kalsotra et al. 2016). Surgeons previously labelled the first few minutes of PT management as the ‘golden hour’, where the quality of medical care during this period will significantly increase or decrease the chances of injury related mortality and morbidity (Rogers et al. 2015).
Relative Mortality Analysis Of The “Golden Hour”: A Comprehensive Acuity Stratification Approach To Address Disagreement In Current Literature
Published in Prehospital Emergency Care, 2019
Philip H. Schroeder, Nicholas J. Napoli, William F. Barnhardt, Laura E. Barnes, Jeffrey S. Young
The “golden hour” of trauma refers to the principle that the sooner a patient receives definitive hospital care following an injury, the greater is the patient’s chance of survival. However, extensive literature reviews have found conflicting evidence regarding the validity of this premise (1, 2). Of studies that found a positive correlation between prehospital time and mortality (3–12), most evaluated either a small sample of patients suffering specific injuries (3–8) or a mixed sample that included nontraumatic cardiac arrest (9, 10). Of studies that evaluated an inclusive sample of solely trauma patients (11–19), seven directly evaluated the relationship between prehospital time and outcome (11, 12, 15–19). Of these, two provided support for the “golden hour” (11, 12), while five failed to identify any patients who benefited from reduced prehospital time (15–19).