Trauma surgery

2014 ◽  
Author(s):  
Sebastian Dawson-Bowling ◽  
Serena Ledwidge
Keyword(s):  
Life Support ◽  
Trauma Surgery ◽  
Clinical Signs ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Definitive Treatment ◽  
Advanced Trauma Life Support ◽  
Mortality And Morbidity ◽  
Golden Hour ◽  
The Uk

Appreciation of the ‘golden hour’ for resuscitation, and adoption of prin­ciples of the advanced trauma life support (ATLS) system are key factors in improving outcome for the patient with major injuries. Adherence to the strict protocols of the ABCDEs of the primary survey enables the trauma team to identify and deal with life-threatening conditions, prior to definitive treatment of problems with lesser immediacy. The clinician who understands the mechanism of injury will main­tain heightened levels of suspicion for clinical signs which point to well-recognized conditions resulting in early mortality and morbidity, for instance, tension pneumothorax, cardiac tamponade, and rising intrac­ranial pressure. This chapter will probe your grasp of the principles of trauma manage­ment. You will also be tested on common patterns of thoracic, abdomi­nal, vascular, and cranial injuries. Whilst clinical presentations of civilian trauma have remained consist­ent in recent years, the impact of military trauma in worldwide theatres of conflict has stimulated numerous advances in the management of trauma. The current impetus for reorganization of trauma services in the UK is tacit acknowledgement of the improvement in outcomes that can be achieved by adherence to recognized protocols in this challenging and demanding field of surgery.

scholarly journals ATLS®: breaking new ground

2013 ◽  
Vol 95 (10) ◽  
pp. 333-333
Author(s):  
Stephen Bush
Keyword(s):  
Differential Diagnosis ◽  
Life Support ◽  
Medical Training ◽  
Trauma Team ◽  
Advanced Trauma Life Support ◽  
Generic Skills ◽  
The Uk

The inaugural Advanced Trauma Life Support (ATLS)® course was run in the UK in 1988 and now over 50 countries worldwide run an ATLS® programme and over a million doctors have been trained. In the early days of ATLS®, its message was ground-breaking. It introduced the ABCDE approach, the generic skills of the trauma team and goal directed care. At the time, this message was at significant odds with the accepted model of history, examination, differential diagnosis, investigation, refinement of the differential and then treatment. It is a testament to the effect that the ATLS® programme has had on medical training throughout the globe that this approach is now the convention.

scholarly journals The rescue of the polytraumatized victims due to violence in transit in the city of Chapecó-SC: the “golden hour”

2020 ◽  
Vol 13 (7) ◽  
pp. 102
Author(s):  
G. A. S. Moser ◽  
D. C. M. Aguiar ◽  
B. C. Franciscon ◽  
J. F. Lima ◽  
F. B. Haag
Keyword(s):  
Customer Service ◽  
Hospital Care ◽  
Life Support ◽  
Fire Department ◽  
Modern Society ◽  
Advanced Trauma Life Support ◽  
Structured Interviews ◽  
The West ◽  
Golden Hour ◽  
Delay Of Care

Trauma is considered the third cause of death, being understood as a disease with endemic character in modern society is not only affecting the field of public health, but also, the socio-political society. According to the Advanced Trauma Life Support - ATLS, in emergencies, the first hour, called the "Golden Hour" (Golden hour), this is the moment in which more deaths occur. However, this is also the time for more if you can avoid them. This study aimed to understand how the pre-hospital care and hospital conducted both by the Fire Department of the west of SC, and by nurses from the emergency department of a regional hospital in the west of Santa Catarina, whereas the reception and customer service in the first hour of trauma ("golden hour") the polytraumatized patients. It is a qualitative, with data collection in the first half of October 2016, through semi structured interviews held with nine Militarized Firemen and four nurses to an emergency room, using as analytical method to Content Analysis of Bardin. In this study, it was observed that within 60 minutes that comprise the golden hour, first medical care which is since the so-called redemption until the reached the hospital, is done quickly and properly in most of the times, ignoring the factors that may delay the answer, as transit, incarceration and away from the occurrence, being the victim transported in a timely manner. This delay in care is often caused by delay of complementary examinations, delay of care by the medical team, deficiency of structure and overcrowding, these factors generate a cascade of delay, which consequently worsen the situation of the patient, increasing morbidity and mortality. You will notice that the golden hour is valuable in that it concerns the maintenance of life and consequences for patients. A quick and effective way can increase the chances of survival of same. It is known that the development of services of APH, whether public or private, culminate with the need for trained and qualified professionals that meet the specific needs of the nursing care during the pre-hospital care, with a view to prevention, protection and recovery to healthIt is of great importance to discuss more about the topic and conduct further studies to develop mechanisms that reduce this time-response thus lowering the risk of sequelae and mortality due to trauma.

The injured patient

2018 ◽  
pp. 21-60
Author(s):  
Mike Perry
Keyword(s):  
Head And Neck ◽  
Life Support ◽  
Clinical Signs ◽  
Injured Patient ◽  
Signs And Symptoms ◽  
Advanced Trauma Life Support ◽  
Neck Injuries ◽  
Complex Decision Making ◽  
Clinical Signs And Symptoms ◽  
Multiply Injured Patient

This chapter gives an overview of the assessment of patients presenting to an emergency department with injuries to head or neck (above the collar bones). The Advanced Trauma Life Support® (ATLS®) programme is now widely accepted as the gold standard in trauma management, but its strict application to patients with coexisting facial injuries can result in a number of dilemmas and complex decision-making. These issues are discussed. The approach to head and neck injuries remains the same as for the multiply injured patient but those aspects related specifically to injuries to the head and neck are discussed in detail. Emergency procedures undertaken in head and neck injuries are also discussed. Useful clinical signs and symptoms indicating significant injuries are listed at the end of the chapter.

Major trauma

2021 ◽  
pp. 581-596
Keyword(s):  
Major Trauma ◽  
Life Support ◽  
Head Injuries ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Thoracic Injuries ◽  
Golden Hour ◽  
Secondary Survey ◽  
Time Periods ◽  
Second Peak

This chapter discusses the management of major trauma. Trauma is the leading cause of death in the first four decades of life, and every minute, more than nine people die from injuries and violence. Trimodal distribution of death implies death from injury occurs in one of three time periods: first peak (within seconds to minutes), second peak (within minutes to several hours), and third peak (after several days to weeks). The ‘golden hour’ refers to the period when medical care can make the maximum impact on death and disability. A systematic, rapid initial assessment is essential and this includes preparation, triage, primary survey (ABCDE), resuscitation, secondary survey, continued monitoring, and reevaluation and definitive care. The chapter then looks at the advanced trauma life support (ATLS) system. It also considers thoracic injuries, abdominal trauma, vascular injuries, and head injuries.

Clinical suspicion regarding needle decompression for patients with chest trauma

2019 ◽  
Vol 11 (8) ◽  
pp. 330-334
Author(s):  
Alastair Beaven ◽  
James Harrison ◽  
Keith Porter ◽  
Richard Steyn
Keyword(s):  
Chest Trauma ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Trauma Network ◽  
Trauma Patients ◽  
Care Providers ◽  
Trauma Population ◽  
The Uk ◽  
Needle Decompression

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

scholarly journals (A215) Delayed Diagnosis of Injury in Survivors of the February 2009 Crash of Flight TK 1951

2011 ◽  
Vol 26 (S1) ◽  
pp. s59-s60
Author(s):  
I.L.E. Postma ◽  
J. Winkelhagen ◽  
T. Bijlsma ◽  
F. Bloemers ◽  
M. Heetveld ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Delayed Diagnosis ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Emergency Intervention ◽  
Plane Crash ◽  
Tertiary Survey ◽  
Clinically Significant ◽  
The Uk

IntroductionIn 2009, a Boeing 737 crashed near Amsterdam, traumatically injuring 126 people. In trauma patients, some injuries initially escape detection. The aim of this study is to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the effects of tertiary survey on the victims of a plane crash.MethodsData collected included documentations of DDI, tertiary surveys, Injury Severity Scale (ISS) score, Glasgow Coma Scale score, number and type of injuries, and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. Comparison was made to a crash in the UK (1989), before advanced trauma life support became practiced widely.ResultsAll 126 victims were evaluated in a hospital emergency department; 66 were admitted with a total of 171 clinically significant injuries. Twelve clinically significant DDIs were found in eight patients (12%). In 65%, a tertiary survey was documented. The DDI incidences differed for several risk factors. Eighty-one survivors of the UK crash had a total of 332 injuries. Of those with > 5 injuries, 5% had a DDI, versus 8% of those with ≤ 5 injuries.ConclusionsThe DDI incidence in this study was 7% of the injuries in 12% of the population. A tertiary survey was documented in 65%; ideally this should be 100%. In this study, a high ISS score, head injury, > 5 injuries, and emergency intervention were associated with DDI. The DDI incidence in the current study was lower than in the UK crash.

Major Trauma

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
High Speed ◽  
Major Trauma ◽  
Trauma Team ◽  
Vital Role ◽  
Trauma Patients ◽  
Ambulance Personnel ◽  
Mortality And Morbidity ◽  
Resuscitation Room ◽  
The Difference ◽  
The Uk

In the UK, trauma is currently the commonest cause of death in people <40 years and its incidence is predicted to rise over the next 20 years. So you have an important role in the assessment and management of this group of patients. Doctors of the ED perform a vital role in the early stages of management of trauma patients. In patients with multiple injuries, the care is delivered by a trauma team constituted by middle-grade doctors from various specialties. A senior doctor, usually from the ED and with training in dealing with trauma, leads the team. The trauma team is often requested by the prehospital ambulance personnel, but this is not always the case. Although in your first few days you would not be expected to manage such situations on your own, you may come across a patient with serious trauma behind the curtains in a cubicle. Recognizing the seriousness of the situation and calling for help in the form of a trauma team may make all the difference to that patient in terms of recovery. The principles of assessment and management of trauma patients are discussed in the first answer of this chapter. The ATLS course introduces you to the principles of early management of trauma victims and this can be applied to any trauma patient whom you will see in the ED. The skills you learn on the ATLS course are applicable in many situations. It is advisable to attend this training course while you are working in the ED. You should suspect major trauma in the following situations: • Related to vehicles: high-speed collisions, victim’s ejection from the vehicle (partial or total), rollover, prolonged extrication, etc. • Death of a co-passenger • Pedestrians run over or thrown away to a distance, or with a significant impact (>20mph/32kph) • Falls from a height of >6m in adults and >3m in children or two to three times the height of the child. Resuscitation in the first hour in the resuscitation room has been proved to reduce mortality and morbidity among trauma patients, and so it might be you who will have saved the life of an individual.

Survey Penyebab Kematian Berdasarkan Prosedur Advance Trauma Life Support (ATLS) pada Pasien Multiple Trauma di Instalasi Gawat Darurat (IGD) Bedah Rumah Sakit Hasan Sadikin Bandung Periode Januari – Juli 2014

2018 ◽  
Vol 9 (1) ◽  
pp. 10
Author(s):  
Gamal Ramadiputra ◽  
Yoyos Dias Ismiarto ◽  
Herry Herman
Keyword(s):  
Multiple Trauma ◽  
Life Support ◽  
Advance Trauma Life Support ◽  
Advanced Trauma Life Support ◽  
Golden Hour

Trauma adalah penyebab kematian utama pada usia di bawah 44 tahun di Amerika Serikat (AS).  Di Indonesia, trauma menjadi penyebab kematian utama pada kelompok umur 15 – 24 tahun, dan nomor 2 pada kelompok usia 25 – 34 tahun.  Penyebab umumnya ialah kecelakaan lalulintas, diikuti jatuh dari ketinggian, luka bakar dan karena kesengajaan (usaha pembunuhan atau kekerasan lain dan bunuh diri). Salah satu perintis pelayanan kedaruratan medik termasuk kasus trauma adalah Dr. Adams R. Cowley, dari beliau muncul konsep “The golden hour”. Pelatihan Advanced Trauma Life Support (ATLS) dimulai pada tahun 1980 di Alabama, AS, dan atas prakarsa Dr. Aryono D. Pusponegoro, Ketua Komisi Trauma IKABI pusat, mulai 1995 kursus ATLS terselenggara di Indonesia. Penelitian ini dilakukan secara retrospektif dalam kurun waktu Januari sampai Juli 2014 dengan jumlah pasien meninggal di instalasi gawat darurat bedah Rumah Sakit Hasan Sadikin Bandung sebanyak 58 pasien. Melalui penelitian ini akan ditelusuri penyebab kematian dilihat dari segi pertolongan pertama ketika pasien datang ke instalasi gawat darurat, dengan mengacu kepada prosedur Advanced Trauma Life Support (ATLS) yang biasa diterapkan. Hasilnya, pasien meninggal di instalasi gawat darurat bedah Rumah Sakit Hasan Sadikin Bandung dari Januari sampai Juli 2014 sebanyak 58 pasien, sebanyak 6 pasien (10,34%) meninggal pada satu jam pertama, 12 pasien (20,68%) meninggal pada satu sampai enam jam pertama. Dinilai dari segi prosedur Advanced Trauma Life Support (ATLS), mayoritas mengalami kegagalan pada tahap disability (D), yaitu sebanyak 41 pasien meninggal (70,06%), pada tahap circulation (C) sebanyak 10 pasien (17,24%), pada tahap breathing (B) sebanyak 6 pasien (10,34%) dan tahap airway (A) sebanyak 1 pasien (1,72%). 

Trauma Resuscitation

2015 ◽  
Author(s):  
Joaquim M. Havens ◽  
Ali S. Raja
Keyword(s):  
Local Community ◽  
Life Support ◽  
Traumatic Injury ◽  
Empirical Therapy ◽  
Trauma Team ◽  
Needle Insertion ◽  
Advanced Trauma Life Support ◽  
Abdominal Sonography ◽  
Computed Tomographic ◽  
Severe Traumatic Injury

Although patients with recently sustained traumatic injuries may present at any health care setting, this review focuses on resuscitation, stabilization, and management of the trauma patient in the emergency department. Patients with potentially severe traumatic injury often present to local, community hospitals and may require transfer to a trauma center after evaluation. Nevertheless, as long as it does not delay transfer unnecessarily, the initial evaluation can be undertaken in any setting. This review discusses assessment and stabilization, including triage and preparation, trauma team management, bedside evaluation, and supportive care and empirical therapy; diagnosis, including secondary evaluation and management, laboratory testing, and additional imaging following the secondary evaluation; treatment and disposition; and outcomes. Tables describe advanced trauma life support primary evaluation, the Glasgow Coma Scale, National Emergency X-Radiography Utilization Study low-risk criteria, criteria for a positive diagnostic peritoneal lavage, bedside airway tools and rescue airway devices, and difficult airway predictors. Figures include an illustration showing immobilization of the cervical spine, a computed tomographic scan of an open book pelvic fracture, left-sided traumatic hemothorax, focused abdominal sonography for trauma examination, and the appropriate intercostal spaces of needle insertion. This review contains 5 highly rendered figures, 6 tables, and 115 references.

Sign in / Sign up

Export Citation Format

Share Document