Rural Trauma
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
The advanced Trauma Life Support program, (ATLS), by the American College of Surgeons serves to educate physicians who care for injured patients in emergency rooms—often not at trauma centers. Hedges et al. tried to determine if the practices taught in the course affect survival at rural level 3 trauma centers in the Oregon trauma system [31]. This was a retrospective observational analysis of rural injured patient survival. They identified high-risk groups of patients. There was considerable variation in measured care interventions among the 21 level 3 centers. There was a strong association of transfer to a higher level of care with survival in patients presenting with GCS <9 and in patients with ISS >20 but no hypotension. Transfer to a higher level of care is a key tenant of ATLS. They found the contribution of surgeon presence upon initial resuscitation, ED intubation, and blood product administration warranted further study.
Acquired Bleeding Disorders Associated with the Character of the Surgery
Harold R. Schumacher, William A. Rock, Sanford A. Stass in Handbook of Hematologic Pathology, 2019
The surgeon and emergency room physician will more than likely use the Advanced Trauma Life Support program developed by The American College of Surgeons as reported by Trunkey (121). The distinctive aspect of this program is that all activities are performed simultaneously: assessment, resuscitation, complete physical examination, diagnostic procedures, and life-saving surgery. Under resuscitation, the prevention of shock and assessment for blood loss will involve obtaining a blood sample and giving replacement fluids including blood and blood components. For those of us not in the trauma facility, the urgency of this approach is not always apparent. Immediate assessment, often based on clinical experience alone, creates for the distant observer a nonscientific appearance. To reconcile the potential for this problem to dominate any discussion, we have chosen to make each trauma situation an opportunity for growth and education. Each trauma is different, with unique demands. A simplified, rote approach does not provide what is needed. To begin an approach we need a working definition: Massive Blood Transfusion in Trauma; (a) one half blood volume at one time (5–6 units blood for a 70-kg victim), or (b) total blood volume replaced in 24 hr (10–12 units packed red blood cells). The basis for transfusion is based on need, and the need is sometimes criteria based and sometimes based on clinical experience (see Table 8).
Acute facial palsy
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
Due to the nature of force required, the majority of patients with temporal bone fractures will have multiple injuries, including possible intracranial and cervical spine injury. Therefore, initial assessment follows advanced trauma life support protocols with multidisciplinary involvement. Once the patient is stabilised, a complete neuro-otological examination is required, including otoscopy for haemotympanum/perforated eardrum, evidence of postauricular ecchymosis (Battle’s sign), CSF leak from the ear or nose and, in the conscious patient, assessment of facial nerve function, nystagmus and hearing loss (bedside tuning fork test and formal audiometric testing at the earliest opportunity). In the critically ill patient, rapid imaging with high-resolution CT is essential to evaluate the temporal bone but also the intracranial contents and potential cervical spine injury.
Training in polytrauma management in medical curricula: A scoping review
Published in Medical Teacher, 2020
Junior doctors in the emergency department are amongst the first to manage PT patients and provide them with initial resuscitation and care (Price and Hughes 1998; Carley and Driscoll 2001). Yates et al. conducted a study on the management of patients with major trauma presenting to 33 UK hospitals over a 2-year period and found that in 57% (826/1556) of cases of severe trauma (injury severity score ≥16) a senior house officer was in charge of the initial resuscitation (Yates et al. 1992). Training of surgical trainees, such as senior house officers, in the management of PT, is therefore, of clinical relevance, particularly when initial management during the ‘golden hour’ is correlated with clinical outcomes. At the postgraduate level many surgical trainees complete the Advanced Trauma Life Support (ATLS®) course, which provides training on early care of PT patients; however not all surgical trainees working in emergency departments or in acute surgical specialties have completed this training. A study by Graham and Sinclair (1996) found only 24% (28/119) of surgical trainees in acute surgical specialties in the West of Scotland had completed the ATLS®, while a study in the Republic of Ireland by Moholkar et al. (2004), across 26 hospitals providing acute trauma care, reported only 34% (167/488) were ATLS® trained (Graham and Sinclair 1996; Moholkar et al. 2004). Therefore, many surgical trainees, who take charge of the initial management of PT in their day-to-day clinical work may only have had training in PT in their undergraduate medical education.
Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study
Published in Journal of Investigative Surgery, 2019
Tao Cheng, Rong-Gang Xia, Shi-Kui Dong, Xiao-Yu Yan, Cong-Feng Luo
Decisions for the timing and technique of fracture fixation were made after discussions with the orthopedic surgeon and analgesist based on the medical records and radiograph results prior to operation. Plate fixation was preferentially used when IMN might be impossible or technically difficult, such as for fractures that extended into either the hip or knee joints, or an excessively narrow intramedullary canal. Based on the principles of Advanced Trauma Life Support and Risk-Adapted Damage Control, patients were treated operatively if they were deemed physiologically stable enough for surgery. Temporary relative stability was achieved by initial external fixation or skeletal traction before definitive stabilization. Four senior surgeons performed all operations (19, 32, 36, and 39, respectively).
Challenges to improving patient outcome following massive transfusion in severe trauma
Published in Expert Review of Hematology, 2020
According to the data from trauma patients captured into the German TraumaRegistry database (TR-DGU), the percentage of patients in need for immediate transfusion of blood products upon Emergency Room (ER) arrival has declined consistently over the last two decades, from 42% prior to the year 2000, to 19% in 2009 and to 7% in 2017 [6]; in the same registry, the percentage of patients in need for a massive transfusion decreased from 12,4% in 2002 to 1,4% in 2017 (Figure 1). The proportion of major trauma patients receiving a massive transfusion reported from single-center cohort in Australia (n = 5,915 patients) decreased from 8,2% to 4,4% (p < 0,001) between 2006 and 2011 [7]. This decline can be mainly attributed to improvements in both pre-hospital and early in-hospital trauma management through the implementation of standardized protocols and algorithms for acute care surgery and resuscitation (e.g. Pre-hospital/Advanced Trauma Life Support (PHTLS and ATLS), Damage Control Resuscitation (DCR) and Damage Control Surgery (DCS) principles), as well as overall improved and more selective fluid resuscitation strategies, thereby avoiding the detrimental ‘lethal triad of death’.
Related Knowledge Centers
- Airway Management
- Palpation
- Tracheal Tube
- Resuscitation
- Injury
- Trauma Center
- Window of Opportunity
- Abc
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