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 Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Christine M. Van Dillen ◽  
Matthew R. Tice ◽  
Archita D. Patel ◽  
David A. Meurer ◽  
Joseph A. Tyndall ◽  
...  
Keyword(s):  
Confidence Level ◽  
Simulation Training ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Patients ◽  
Care Providers ◽  
Confidence Levels ◽  
Life Saving ◽  
Before And After ◽  
Needle Decompression

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training.Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel.Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42;P<0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77).Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

Cadaveric comparison of the optimal site for needle decompression of tension pneumothorax by prehospital care providers

2015 ◽  
Vol 79 (6) ◽  
pp. 1044-1048 ◽  
Author(s):  
Kenji Inaba ◽  
Efstathios Karamanos ◽  
Dimitra Skiada ◽  
Daniel Grabo ◽  
Peter Hammer ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Care Providers ◽  
Needle Decompression ◽  
Optimal Site

SP9.1.7 Emergency Laparotomy for Trauma in the United Kingdom and Ireland: a Prospective Multicentre Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Paul Vulliamy ◽  
Max Marsden ◽  
Richard Carden ◽  
Karim Brohi ◽  
Ross Davenport ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Prehospital Care ◽  
Trauma System ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Transfusion Rate ◽  
Young Males ◽  
Prospective Multicentre Study ◽  
The Uk ◽  
Emergency Abdominal Surgery

Abstract Aims Trauma patients requiring abdominal surgery have significant morbidity and mortality, but are not included in existing national audits of emergency laparotomy. The aim of this study was to examine processes of care and outcomes among trauma patients undergoing emergency abdominal surgery in the UK and Ireland. Methods A prospective trainee-led multicentre audit was conducted over six months from January 2019 across the national trauma system. Patients undergoing laparotomy or laparoscopy within 24 hours of injury were included. Subgroup analysis was conducted in those requiring major haemorrhage protocol (MHP) activation. Results The study included 363 patients from 34 hospitals (22 major trauma centres). The majority were young males with no co-morbidities who required surgery for control of bleeding (51%) or exploration of penetrating injuries (46%). Over 85% received consultant-led care in the emergency department (318/363) and operating theatre (321/363). The MHP subgroup made up 45% of the cohort but accounted for 97% of deaths and 79% of ICU days, with a mortality rate of 19% and a massive transfusion rate of 32%. Compared to non-MHP patients they had shorter times to theatre (122 vs 218 minutes, p &lt; 0.001), higher rates of advanced prehospital care (60% vs 33%, p &lt; 0.001) and higher rates of consultant-led care (95% vs 85%, p &lt; 0.001). Conclusion The majority of trauma patients requiring emergency abdominal surgery receive consultant-delivered perioperative care which is appropriately tailored to patient risk profile. Despite this, mortality and resource utilization among high-risk patients remains substantial, justifying ongoing performance improvement initiatives and research into novel therapeutics.

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.

Opportunity for Seatbelt Usage by ALS Providers

1991 ◽  
Vol 6 (4) ◽  
pp. 469-471 ◽  
Author(s):  
Richard T. Cook ◽  
Steven A. Meador ◽  
Barry D. Buckingham ◽  
Lee V. Groff
Keyword(s):  
Cardiac Arrest ◽  
Time Management ◽  
Prehospital Care ◽  
Seat Belt ◽  
Cardiac Arrest Patient ◽  
Trauma Patients ◽  
Care Providers ◽  
Seat Belts ◽  
Additional Information ◽  
The Mean

AbstractPurpose:Prehospital care providers commonly indicate that they cannot wear seat belts owing to their need to be unrestrained while delivering care to the patient in the back of the ambulance. Each year, providers are injured in situations in which seat belts have been shown to be protective. Are ALS providers able to wear a seat belt and provide care in an ambulance?Methods:The ALS providers were asked to complete a form following calls during which they rode with a patient in the back of an ambulance. They indicated the amount of time which they felt they would have needed to have been unrestrained by seat belts and the reasons. There were no attempts to regulate or quantify seat belt usage. Additional information was gathered from the trip report.Results:The percentage of the time of each trip during which they felt they needed to be unrestrained was calculated for each trip. The mean was 41%. The mean transport time was 14.7 minutes. Sub-groupings by protocol type, showed that for cardiac arrest patients, providers felt they needed to be unrestrained for 82% of the duration of transport, for patients with “chest pain or cardiac dysrhythmia” 63%, for “shortness of breath” 38%, and for trauma patients 41%. Excluding cardiac arrest patients, the nine patients were assigned by the providers to have the most critical level of case severity required unrestrained time of 72%. Those nine patients with the lowest severity level requires that the provider by unrestrained only 18% of the time. Management of intravenous line and patient assessments most frequently were cited as reasons for needing to be unrestrained.Conclusion:Perceived need of ALS providers to be unrestrained varied with respect to the type of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of calls. The ALS providers should be able to wear seat belts for at least part of the time, on most ALS calls.

scholarly journals P043: Trauma team leaders in Canada: A national survey

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S78
Author(s):  
V. Belhumeur ◽  
C. Malo ◽  
A. Nadeau ◽  
S. Hegg ◽  
A. Gagné ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Injured Patient ◽  
Trauma Team ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Lack Of Information ◽  
Level 1 ◽  
Patient Prognosis ◽  
Activation Criteria ◽  
Early Trauma

Introduction: It was demonstrated that the early trauma team activation (TTA) could improve younger trauma patients outcomes and mortality rates. However, the link between older patient prognosis improvement and the activation / effectiveness of the Trauma team (TT) is still unclear. There is also a lack of information about the exact and optimal structure of TTs and their activation criteria, which may differ across centers. The main objective of this study is to provide a description of the current TT available in level 1 and 2 centres across Canada. Methods: In 2017, a survey using a modified Dillman technique was sent to 210 health professionals scattered across all Canadian trauma care facilities. The survey included questions regarding 1) the presence and the composition of a TT, 2) the established TT activation criteria, and finally 3) the initial patient care. Results: A total of 107 (57%) completed surveys were received. Among them, only 22 (11.7%) were from level 1 or 2 centres and were therefore considered for analyses. Seventeen respondents had a TT in their centre, and they all shared their TT activation criteria (1 to 27 different indications). Most frequently mentioned criteria were: suspected injuries (58.8%), judgment of the emergency physician (41.2%), systolic blood pressure (47.1%), Glasgow Coma score (35.3%) and respiratory rate (28%). In presence of a prehospital care warning trauma, the initial assessment of a severely injured patient is exclusively completed by a member of the TT for only 35.1% of the respondents. For 11.8% of respondents, TT coordinates airway management. For 64.7% of participants, the TT leader is the dedicated care provider to accompany patients until final orientation. Conclusion: These results suggest a great variability across Canada regarding the roles assumed by the TT, but also regarding the activation criteria leading them to take action.

Trauma pan-scan in resuscitative endovascular occlusion:

2017 ◽  
Vol 1 (1) ◽  
pp. 28-33
Author(s):  
Yosuke Matsumura ◽  
Junichi Matsumoto
Keyword(s):  
Trauma Team ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Appropriate Use ◽  
Common Cause ◽  
Flow Disruption ◽  
Endovascular Occlusion ◽  
Trauma Population ◽  
Anatomical Imaging ◽  
Polytrauma Patients

Trauma pan-scan (TPS) offers a benefit in trauma care. Resuscitative endovascular resuscitative endovascular occlusion of the aorta (REBOA) may allow the opportunity to scan hemodynamically unstable (HU) polytrauma patients; however, the benefits and risks of REBOA-TPS remains unknown. The rationale for TPS in HU patients is to choose the best disposition and to quickly achieve hemostasis rather than directly initiating surgery without scanning. TPS would most benefit geriatric trauma patients and those with coagulopathies with unidentified bleeding sources, particularly non-cavitary hemorrhage in blunt trauma and accompanying brain injury, because TPS may predict unexpected physiological collapse by anatomical imaging. CT is a common cause of flow disruption, but trauma team training shortened the time spent in the CT room from 16.8 to 7.3 minutes (P<0.001). While REBOA-TPS cannot be utilized widely and indiscriminately, its appropriate use may increase the salvageable trauma population.

scholarly journals 251 The frailty in major trauma study (FRAIL-T): feasibility of nurse lead frailty assessment in elderly trauma and the impact on outcomes

2020 ◽  
Vol 37 (12) ◽  
pp. 840.2-840
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Bebhinn Dillane ◽  
Chao Wang ◽  
...  
Keyword(s):  
Best Practice ◽  
Major Trauma ◽  
Frailty Index ◽  
Kappa Statistic ◽  
Trauma Team ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Trauma Population ◽  
The Impact

Aims/Objectives/BackgroundFrailty screening for major trauma patients has recently become part of the best practice commissioning tariff within NHS England, yet there is no consensus as to who should carry out this assessment or which tool best identifies frailty in the Emergency Department (ED). As the trauma population ages there is a need for accurate early identification of frailty in the ED to underpin frailty specific major trauma pathways. The primary aim of this study was to determine the feasibility and accuracy of ED nurse-led frailty assessment in patients ≥ 65 years admitted to Major Trauma Centres (MTCs).Methods/DesignA prospective observational study was conducted across five UK MTCs, enrolling 370 participants over nine months. Eligible patients were aged 65 or more requiring trauma team activation. Frailty was assessed in the ED using three different tools: Trauma Specific Frailty Index (TSFI); Clinical Frailty Scale (CFS); PRISMA-7. ED nurse frailty assessment was correlated with Geriatrician assessment within 72 hours of admission using Spearman’s correlation coefficient and kappa statistic for measuring the interrater agreement.Results/ConclusionsComplete frailty assessments were calculated for CFS in 99.4% of patients, PRISMA7 in 95.9% and TSFI in 37.58%. Rates of frailty differed between tools: CFS 32%, PRISMA7 57% and TSFI 92% whilst Geriatrician determined frailty was 37%. In all tools frail patients were older (p<0.001) and falls <2 m were the leading mechanism of injury (p<0.05). CFS showed both strong correlation (rs 0.639,p<0.001) and substantial agreement (kappa 0.637,p<0.001) with Geriatrician assessment within 72 hours of admission.ED nurses can accurately assess older major trauma patients for frailty using the Clinical Frailty Scale. These findings support assessment of frailty in the ED in order to identify patients who would benefit from early frailty specific care.

scholarly journals Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Michael Eichinger ◽  
Henry Douglas Pow Robb ◽  
Cosmo Scurr ◽  
Harriet Tucker ◽  
Stefan Heschl ◽  
...  
Keyword(s):  
Older People ◽  
Scoping Review ◽  
Prehospital Care ◽  
Descriptive Analysis ◽  
Traumatic Injury ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Care Providers ◽  
Age Bias ◽  
Prehospital Management

Abstract Background Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. Methods and findings A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. Conclusions Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

scholarly journals (A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India

2011 ◽  
Vol 26 (S1) ◽  
pp. s5-s5
Author(s):  
N.A. Lodhia ◽  
M. Strehlow ◽  
E. Pirrotta ◽  
B.N.V. Swathi ◽  
A. Gimkala ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Initial Study ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Care Providers ◽  
Elderly Age ◽  
Post Injury ◽  
Lower Socioeconomic ◽  
Prehospital Emergency

BackgroundNon-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.MethodsAll patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.ResultsA total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.ConclusionThis initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.

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