Acute Care SINS: Surgical Insights for the Non-surgeon

2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Deng Mapiour MD ◽  
Peter G. Brindley MD ◽  
Ronald Brisebois ◽  
Rachel G. Khadaroo MD PhD
Keyword(s):  
Causes Of Death ◽  
Major Trauma ◽  
Life Support ◽  
Myocardial Damage ◽  
Advanced Trauma Life Support ◽  
Medical Practitioners ◽  
Post Traumatic ◽  
Manual Skills ◽  
Robust Systems ◽  
Resuscitation Team

Fortunately, trauma care is evolving rapidly. Unfortunately, trauma is still ubiquitous and still one of the leading causes of death, especially amongst the young. Trauma skills are now widely taught to surgeons and non-surgeons alike via courses such as the Advanced Trauma Life Support course and the Simulated Trauma and Resuscitation Team Training course. These practical courses emphasize that the initials “MD” really mean “make a decision.”Medical practitioners should understand trauma as a complex, multisystem, and multistage disease. For example, major trauma can cause enormous physiological stresses.This means that frail patients may not survive the acute insultand that others will be left battling the medical consequences (infections, myocardial damage, rhabdomyolysis, wound healing, etc.). Trauma also creates substantial psychological burdens for both patients and caregivers, whether through lost income, depression, divorce, or post-traumatic stress.Above all, there is a growing acceptance that in order to vanquish trauma, we need comprehensive and robust systems, not just doctors trained in isolation. Trauma is evolving into a fascinating science that blends knowledge, manual skills, ongoing practice, and system-wide commitment. Accordingly, trauma belongs in the bailiwick of both surgeons and non- surgeons. This chapter offers a basic primer. If you can establish the mechanism, apply anatomy, and find a modicum of courage, then patients may increasingly live to tell the tale.

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.

The Efficacy of Integrating “Smart Simulated Casualties” in Hospital Disaster Drills

1997 ◽  
Vol 12 (2) ◽  
pp. 26-30 ◽  
Author(s):  
Ofer N. Gofrit ◽  
Dan Leibovici ◽  
Joshua Shemer ◽  
Avinoam Henig ◽  
Shmuel C. Shapira
Keyword(s):  
Medical Care ◽  
Life Support ◽  
Medical Condition ◽  
Medical Knowledge ◽  
Hospital Staff ◽  
Medical Documentation ◽  
Advanced Trauma Life Support ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Quality Of Medical Care

AbstractIntroduction:Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill.Objective:To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill.Methods:A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as “Smart Victims.” The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill.Results:The “smart casualties” made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The “smart casualties” were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals.Conclusion:Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.

Launch of the ATLS® 8th edition

2009 ◽  
Vol 91 (3) ◽  
pp. 84-85
Author(s):  
Rosalind Roden
Keyword(s):  
Gold Standard ◽  
Major Trauma ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Common Language ◽  
Early Management ◽  
Wide Range ◽  
Eighth Edition ◽  
The Uk ◽  
8Th Edition

On 27 March 2009 The Royal College of Surgeons of England will host the launch of the eighth edition of the Advanced Trauma Life Support® (ATLS®) programme in the UK. ATLS® has just entered its 21st year of life in the UK. The courses are run in 120 regional centres and in 2008 trained over 4,200 providers. ATLS® represents the gold standard for those involved in the early management of major trauma. The programme currently has over 600 active instructors from a wide range of specialties, including general surgery, emergency medicine, trauma and orthopaedics, anaesthesiology and radiology. More than anything ATLS® promotes a common language among those of us who work together to care for trauma victims.

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

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).

Sechs Jahre Advanced Trauma Life Support (ATLS) in Deutschland

2010 ◽  
Vol 113 (7) ◽  
pp. 561-567 ◽  
Author(s):  
M. Münzberg ◽  
L. Mahlke ◽  
B. Bouillon ◽  
T. Paffrath ◽  
G. Matthes ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Trauma Life Support

Pediatric Emergency Medicine: A Developing Subspecialty

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 336-342
Author(s):  
Marilyn Li ◽  
M. Douglas Baker ◽  
Leland J. Ropp
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Emergency Departments ◽  
Life Support ◽  
Pediatric Emergency ◽  
Advanced Trauma Life Support ◽  
Full Time ◽  
Pediatric Emergency Medicine ◽  
Pediatric Hospitals ◽  
Pediatric Emergency Care

Questionnaires were sent to 245 North American institutions with pediatric residency programs. There was a 69% response rate. Pediatric emergency care is provided in three types of facilities: emergency departments in pediatric hospitals, separate pediatric emergency departments or combined pediatric and adult emergency departments, in multidisciplinary hospitals. There are at least 262 pediatricians practicing full-time pediatric emergency medicine. The majority work in pediatric emergency departments, an average of 30.7 clinical hours per week. There are 27 pediatric emergency medicine programs with 46 fellows in training and 117 full-time positions available for emergency pediatricians throughout North America. Varying qualifications for these positions include board eligibility in pediatrics, certification in Basic Life Support or Advanced Trauma Life Support, and a fellowship in pediatric emergency medicine. The demonstrated need for pediatricians, preferably trained in emergency care, clearly indicates that pediatric emergency medicine is a rapidly developing subspecialty of Pediatrics that will be an attractive career choice for future pediatricians.

Injuries to the Neck

2015 ◽  
Author(s):  
David H. Wisner ◽  
Joseph M. Galante
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Life Support ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Neck Trauma ◽  
Anatomical Structures ◽  
Initial Management

Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated rates of morbidity and mortality. Airway management in trauma does not differ based on the mechanism of injury, and so the initial priority is to ensure an adequate airway through cricothyrotomy or tracheotomy. For penetrating neck trauma, initial management is evaluated in accordance with Advanced Trauma Life Support (ATLS) guidelines. Thereafter, the management of penetrating trauma of the stable patients is provided and includes carotid artery exploration and repair, vertebral artery exploration and repair, endovascular repair, jugular vein injuries, treatment of the pharynx and esophagus, and treatment of the larynx and trachea. Blunt trauma is described and includes injuries to the aerodigestive tract and cerebrovascular and vertebral injuries. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular vein, pharynx, and esophagus; the three separate zones of the neck; common incisions made along the sternocleidomastoid muscle; important anatomical structures of the neck; and an algorithm outlining management of known injuries to the vertebral artery. This chapter contains 31 references.

Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

1989 ◽  
Vol 4 (2) ◽  
pp. 135-152 ◽  
Author(s):  
Miroslav Klain ◽  
Edmund Ricci ◽  
Peter Safar ◽  
Victor Semenov ◽  
Ernesto Pretto ◽  
...  
Keyword(s):  
Intensive Care ◽  
Life Support ◽  
Medical Personnel ◽  
The United States ◽  
Structured Interview ◽  
Advanced Trauma Life Support ◽  
Mass Casualties ◽  
Medical Systems ◽  
Preliminary Results ◽  
Medical Teams

AbstractIn general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).

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

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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