Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

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Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

10.21203/rs.3.rs-147008/v1 ◽

2021 ◽

Author(s):

Adel Hamed Elbaih ◽

Maged El-Setouhy ◽

Jon Mark Hirshon ◽

Hazem Mohamed El-Hariri ◽

Mohamed El-Shinawi

Keyword(s):

Low Income ◽

Life Support ◽

University Hospital ◽

Low Income Countries ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Education Programs ◽

Missed Injuries ◽

Polytrauma Patients ◽

Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

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Medical and surgical devices in the emergency and trauma patient: what the radiologist should know, and how they can add value

British Journal of Radiology ◽

10.1259/bjr.20200530 ◽

2020 ◽

pp. 20200530

Author(s):

Marcela De La Hoz Polo ◽

Amandeep Sandhu ◽

Elika Kashef ◽

Christopher Aylwin ◽

Duncan Bew ◽

...

Keyword(s):

Medical Devices ◽

Life Support ◽

Formal Training ◽

Trauma Patients ◽

Acute Setting ◽

Endotracheal Tubes ◽

Acute Trauma ◽

Radiological Appearance ◽

Surgical Devices ◽

Limited Experience

A variety of different external and internal medical devices are used in the acute setting to maintain life support and manage severely injured and unstable trauma or emergency patients. These devices are inserted into the acutely ill patient with the specific purpose of improving outcome, but misplacement can cause additional morbidity and mortality. Consequently, meaningful interpretation of the position of devices can affect acute management. Some devices such as nasopharyngeal, nasogastric and endotracheal tubes and chest and surgical drains are well known to most clinicians, however, little formal training exists for radiologists in composing their report on the imaging of these devices. The novice radiologist often relies on tips and phrases handed down in an aural tradition or resorts to phrases such as: “position as shown”. Furthermore, radiologists with limited experience in trauma might not be familiar with the radiological appearance of other more specific devices. This review will focus on the most common medical devices used in acute trauma patients, indications, radiological appearance and their correct and suboptimal positioning.

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Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Critical Care Nurse ◽

10.4037/ccn2013395 ◽

2013 ◽

Vol 33 (6) ◽

pp. 18-24 ◽

Cited By ~ 7

Author(s):

Stavros Gourgiotis ◽

George Gemenetzis ◽

Hemant M. Kocher ◽

Stavros Aloizos ◽

Nikolaos S. Salemis ◽

...

Keyword(s):

Clinical Trials ◽

Life Support ◽

Operative Management ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Permissive Hypotension ◽

Randomized Controlled Clinical Trials ◽

Resuscitation Fluid ◽

Crystalloid Solutions ◽

Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

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Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

Prehospital and Disaster Medicine ◽

10.1017/s1049023x14000879 ◽

2014 ◽

Vol 29 (5) ◽

pp. 473-477 ◽

Cited By ~ 9

Author(s):

Mohammad Paravar ◽

Mehrdad Hosseinpour ◽

Mahdi Mohammadzadeh ◽

Azade Sadat Mirzadeh

Keyword(s):

Hospital Mortality ◽

Trauma Center ◽

Injury Severity ◽

Life Support ◽

Prehospital Care ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Publication Type ◽

Transport Time ◽

Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

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“A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children

The American Surgeon ◽

10.1177/000313481908500524 ◽

2019 ◽

Vol 85 (5) ◽

pp. 479-487

Author(s):

Andrea N. Doud ◽

Michaela Gaffley ◽

Olivia Hostetter ◽

Jennifer W. Talton ◽

John K. Petty

Keyword(s):

Endotracheal Tube ◽

Life Support ◽

Pediatric Trauma ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Primary Survey ◽

Breath Sounds ◽

Before And After ◽

Chest X Ray ◽

Baseline Characteristics

The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.

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Incidental Findings in Trauma Patients during Focused Assessment with Sonography for Trauma

The American Surgeon ◽

10.1177/000313481207800349 ◽

2012 ◽

Vol 78 (3) ◽

pp. 366-372 ◽

Cited By ~ 2

Author(s):

Sophocles Lanitis ◽

Constantinos Zacharioudakis ◽

Paraskevi Zafeiriadou ◽

Vasileios Armoutides ◽

Charilaos Karaliotas ◽

...

Keyword(s):

Incidental Findings ◽

Life Support ◽

Univariate Analysis ◽

Biliary Tree ◽

Initial Assessment ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Management Algorithm ◽

Surgical Conditions ◽

Mechanism Of Trauma

During the initial assessment of trauma patients they usually undergo a Focused Assessment with Sonography for Trauma (FAST) in which there are occasionally incidental findings of other surgical conditions. In this audit we discuss the incidence, demographics, and implications of these findings and we propose a management algorithm. Within 2 years we managed 6041 trauma patients in the emergency department based on the Advanced Trauma Life Support protocols, 95 per cent of which underwent a FAST ultrasound. Incidental findings were reported in 468 patients (7.8%), whereas in a further 11.2 per cent of these patients there was a second finding. The mean age of these patients was 57.55 years (15–105), and most of them were men (51.1%). The vast majority of the findings were related to the liver and biliary tree (52.1%) followed by the urinary track (27.1% 1 8%). In multivariate analysis only the age was a significant factor associated with incidental findings ( P < 0.001) whereas in univariate analysis both the gender [men (54.1%) vs women (45.9), P = 0.013] and the mechanism of trauma ( P < 0.001) were as important as the age ( P < 0.001). The patients who had incidental findings were 15 years older than the rest. The detection of unknown surgical conditions in FAST may lead to managerial and possible medico-legal issues rendering the development of a proper algorithm mandatory.

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

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002056 ◽

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.

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Effect of team training on efficiency of trauma care in a Chinese hospital

Journal of International Medical Research ◽

10.1177/0300060517717401 ◽

2017 ◽

Vol 46 (1) ◽

pp. 357-367 ◽

Cited By ~ 1

Author(s):

Yucai Hong ◽

Xiujun Cai

Keyword(s):

Propensity Score ◽

Emergency Room ◽

Trauma Care ◽

Life Support ◽

Propensity Score Analysis ◽

Team Training ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Traditional Practice ◽

Blood Routine

Objective Multidisciplinary trauma teams are the standard of care in the USA, but staffing differences and lack of advanced trauma life support training hinder replication of this system in Chinese hospitals. We investigated the effect of simulation team training on initial trauma care. Methods Over 15 months, we compared grade I trauma patients cared for by the trained team and those cared for using traditional practice on times from emergency room arrival to tests/procedures. Propensity-score analysis was performed to improve between-group comparisons. Results During the study, 144 grade I trauma patients were treated. Trained team patients showed shorter times from emergency room arrival to initiation of hemostasis (31.0 [13.5–58.5] vs. 113.5 [77–150.50] min), blood routine report (8 [5–10.25] vs. 13 [10–21] min), other blood tests (21 [14.75–25.75] vs. 31 [25–37] min), computed tomography scan (29.5 [20.25–65] vs. 58.5 [30.25–71.25] min) and tranexamic acid administration (31 [13–65] vs. 90 [65–200] min). Similar results were obtained for the propensity-score matched cohort. Conclusion Simulation team training could help reduce time to blood routine reports, scans and hemostasis. Assessment of available resources and development of targeted team training could improve care in resource-limited hospitals.

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Advanced Trauma Life Support training. How useful it is?

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v4i2.4.171 ◽

2020 ◽

Vol 4 (2.4) ◽

Author(s):

Agron Dogjani ◽

Arben Gjata ◽

Kastriot Haxhirexha ◽

Sindi Shandro ◽

Seimir Laqja

Keyword(s):

Life Support ◽

Educational Status ◽

University Hospital ◽

Medical Emergency ◽

Advanced Trauma Life Support ◽

Substantial Part ◽

Trauma Patients ◽

Trauma Service ◽

Police Records ◽

The Right

For more than 20 years, following the changes that took place in Albania in 1992, we receive information from trauma patients in the media about the delivery of trauma services. Police records are worthy of a war balance report. Trauma is estimated to be the cause of deaths in 13.7% / 100,000 people. Every two days three Albanian Citizens die because of Automobile Accidents… Changes have already taken place, but the question arises, who cares about the trauma and its management? Formerly and now the state ... ok ... but? Is this enough? The Ministry of Health should have a “Trauma Committee” if yes… is it active? Already of the three years at the heart of these medical emergency management networks is a National Center of Medical Emergency (NCME). The trauma service delivery is now evolving along the lines of a central and spoken model with a concentration of expertise and specialization in the center surrounded by smaller units that feed on the center. The study showed a 19% increase in the chances of survival since the introduction of these changes. Another 1,600 trauma victims are alive today due to developments in the administration of trauma patients in England over the past six years. In this system or mode of organizing what is today the NCME or organizing the transport of traumatized from the scene to the University Hospital of Trauma... by medical staff who have done a substantial part of the PhTLS® course ... How is the educational status of personal in other regions far from Capital? ATLS® student courses in our country have been implemented by few and individually… ASTES, by default rules, has acquired the right to organize ATLS® in Albania…

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