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A motorcycle accident
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
The patient with major trauma has the potential for many immediately life-threatening injuries. Their identification and management have been revolutionised by the development of a ‘structured approach’ to the trauma patient. This ABCDE concept is designed to ‘identify and treat’ the conditions that are most likely to kill the patient, in the order that they occur. A (airway) has to be assessed and an obstruction relieved. This takes priority over B (breathing), e.g. detect and treat tension pneumothorax before C (circulation), identify and manage haemorrhagic shock etc.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Many children who are injured have minor injuries; injury severity forms a continuum and there is no precise cut-off point between ‘minor’ and ‘major’ trauma. However, a useful definition for ‘major’ trauma is an injury severity score (ISS) of >15. This is, of course, a retrospective measure and unhelpful in the acute setting. Victims of major trauma may have life- or limb-threatening injuries as well as minor fractures or soft-tissue injuries. Physicians managing trauma in children therefore require a broad knowledge base and skill set.
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Major trauma is the widely accepted as the leading cause of mortality and morbidity in patients under 45 years of age [4]. The primary objective of managing this category of patients is to reduce death and disability. This requires interdisciplinary cooperation among paramedics (pre-hospital setting), surgeons, anaesthetists (anaesthesiologists), nurses, radiologists and radiographers (technologists) in the hospital setting. The main task is to stabilise the patient as soon as possible. Here time is the most important factor for mortality and morbidity. Specifically, the time elapsed from the trauma to the resuscitation and therapeutic interventions. The American College of Surgeons’ Advanced Trauma Life Support (ATLS) is the international trauma algorithm used to standardise the resuscitation and subsequent workflows. The ATLS was developed by an orthopaedic surgeon (James Styner) who was involved in a tragic air crash in 1976. His wife was killed, and he and his three children sustained critical injuries. Styner observed the uncoordinated trauma management of himself and his family first hand [5].
The reverse shock index multiplied by Glasgow coma scale (rSIG) is predictive of mortality in trauma patients according to age
Published in Brain Injury, 2023
Eujene Jung, Hyun Ho Ryu, Bang Geul Heo
In Korea, the scoop and run EMS system provide pre-clinical care for patients post-trauma. In such instances, the injured patient is provided with medical care at the site of the trauma before being transported to the relevant medical facility. Examples of the medical care given include measuring the patient’s vital signs, a physical exam, performing basic treatments (i.e., wound dressing), and putting the patient in a neck brace or splint. If hypotension is observed or massive bleeding is suspected, intravenous fluids are often administered under the guidance of the medical director. When major trauma is questioned by the EMS technicians or medical director, the patient is transported to a level-1 trauma center. Major trauma is determined by looking at the patient’s vital signs, mental status, and the mechanism of injury.
Follow-up of severely injured patients can be embedded in routine hospital care: results from a feasibility study
Published in Hospital Practice, 2022
Elizabeth Wake, Caitlin Brandenburg, Kathy Heathcote, Kate Dale, Don Campbell, Magnolia Cardona
To address these concerns, we implemented a Trauma Service Follow-up program (TSFU) into our existing clinical trauma service in 2019. The TSFU is delivered by the clinical staff of the multi-disciplinary trauma service that includes nurses and allied health (physiotherapist and occupational therapists). The aims of the TSFU are to (i) collect long-term outcome data on the major trauma patients who were treated at the hospital; (ii) provide insight into the long-term outcomes of major trauma patients attending our center; and if the program was found to be feasible; (iii) provide a platform on which future interventions in relation to the ongoing care of major trauma patients may occur. The program was modeled on the methods used by VSTORM [10]; however, it differs in that it is implemented by the clinical team who were involved in the care of the patients. The TSFU is novel in Australia in that it was specifically designed to be embedded within the daily work program of the trauma service and was funded from current operational budgets. To assess the feasibility and sustainability of this program, a process evaluation was conducted to evaluate the implementation of TSFU program.
Longer Prehospital Time was not Associated with Mortality in Major Trauma: A Retrospective Cohort Study
Published in Prehospital Emergency Care, 2019
Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn
During the study period, adult trauma patients in the metropolitan area who were transported by SJA-WA would have attended one of nine hospitals: three tertiary and six secondary hospitals. One of the tertiary hospitals was the designated Trauma Center (17). The other two tertiary hospitals provided services for inpatient management of major trauma. The five secondary facilities and one private hospital provided definitive care for non-major trauma (17). For this study, the designated Trauma Center (tertiary hospital), the two other tertiary hospitals and one of the secondary facilities provided data to the State Trauma Registry (including data for those patients transferred to these facilities after initial treatment at a metropolitan hospital that did not provide data to the registry) (18).