scholarly journals Efektifitas Ketepatan Triage Trauma Terhadap Aktivasi Kode Trauma Pada Pasien Trauma Kategori Merah Di Instalasi Gawat Darurat: Literature Review

JKEP ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 29-42
Author(s):  
Fatriani Fatriani ◽  
Masfuri Masfuri ◽  
Agung Waluyo
Keyword(s):  
Emergency Department ◽  
Health Workers ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Initial Management ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Management Priorities

Emergency trauma can occur at any time, occur everywhere and can be experienced by everyone. The speed and accuracy of relief in trauma emergency conditions, will determine the outcome of the assistance provided. Help for trauma patients in the Emergency Department begins when the triage officer receives the patient. The triage process sorts patients according to the patient's emergency condition using parameters of level of consciousness, respiratory status and circulation status of the patient. An efficient trauma triage system aims to assist health workers in identifying life-threatening conditions, making timely assessments and management priorities that are appropriate to the severity of the patient. Trauma Code Activation is implemented as a system for providing emergency relief in cases of trauma in the red category. In some countries the application of Trauma Team Activation in cases of trauma in the red category is the main one to optimize the initial management of trauma emergency department. Trauma Code Activation at Cipto Mangunkusumo Hospital Jakarta Emergency Department from September 2018 to June 2019 totaled 362 cases, consisting of 34.1% head injuries (7.6% bleeding), 19.3% fractures, 13% burns, 6, 7% politrauma, and there are 3.8% died.

Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries

Surgery Today ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 261-267
Author(s):  
Zhi-Jie Hong ◽  
Cheng-Jueng Chen ◽  
De-Chuan Chan ◽  
Teng-Wei Chen ◽  
Jyh-Cherng Yu ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Team Leaders ◽  
Multiple Trauma Patients

The Role of the Emergency Pharmacist in Trauma Resuscitation

2011 ◽  
Vol 24 (2) ◽  
pp. 146-159 ◽  
Author(s):  
Thomas R. Scarponcini ◽  
Christopher J. Edwards ◽  
Maria I. Rudis ◽  
Karalea D. Jasiak ◽  
Daniel P. Hays
Keyword(s):  
Emergency Department ◽  
Rapid Sequence Induction ◽  
Trauma Team ◽  
Pressure Control ◽  
Clinical Situation ◽  
Detailed Knowledge ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Sequence Induction

The clinical pharmacist in the emergency department is now commonly incorporated as a member of the emergency department trauma team. As such, the emergency pharmacist needs to have detailed knowledge of the pharmacotherapy of resuscitation and be able to apply the skills needed to function as a valuable member of this team. In addition to the traditional skills of the discipline of clinical pharmacy, the emergency pharmacist must be familiar with the intricacies of treating life-threatening injuries in an emergent setting and be able to anticipate the direction of the patient’s care. The ability to provide valuable pharmacological interventions throughout the resuscitation and stabilization process requires familiarity with the process of resuscitation, including rapid sequence induction, analgesia and sedation, seizure prophylaxis, appropriate antibiotic and tetanus prophylaxis, intracranial pressure control, hemodynamic stabilization, and any other specific drug therapy that the clinical situation demands. This article discusses the aforementioned pharmacotherapeutic topics and describes the role of the Emergency Pharmacist on the ED trauma team.

Delayed injuries in the emergency department in hospitalised trauma patients

Trauma ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 64-69
Author(s):  
Serhat Orun ◽  
Ayhan Akoz ◽  
Ali Duman ◽  
Kenan Ahmet Turkdogan ◽  
Mevlüt Türe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Injury Rate ◽  
Trauma Team ◽  
Trauma Patients ◽  
Missed Injuries ◽  
Missed Injury ◽  
Radiology Reports ◽  
Hospitalised Patients ◽  
Clinical Consequences ◽  
Emergency Service Workers

Introduction Busy emergency departments are associated with medical errors in care and evaluation for unstable trauma patients. Our study aimed to determine the extent, causes and adverse clinical consequences of missed injuries and delayed diagnoses in patients hospitalised with trauma in a Turkish Level 3 emergency department, and provide recommendations for emergency service workers and supervisors to help them reduce the number of injury diagnoses that are delayed. Methods In our prospective study, a total of 515 emergency department patients presenting with trauma between 1 July 2014 and 1 July 2015 were examined by an emergency physician and by a consultant, if necessary. Identified injuries were recorded using case forms, and hospitalised patients were discharged when their treatment was completed. After the patients were discharged their files were reviewed again and new injuries, different from those recorded in the case forms, were investigated. Results Of the 515 patients included, it was shown that an injury diagnosis had been delayed in 21 (3.9%). Of these injuries, 65% were related to the musculoskeletal system. Insufficient clinical evaluation of 95% of the patients who had a missed injury was identified, and, in 70% of missed injuries, the radiology reports had been delayed or incorrectly completed. Conclusion We believe that the delayed injury rate can be reduced in trauma patients with the use of fast and reliable radiological support and the intervention of a multidisciplinary trauma team.

The use of Penthrox (methoxyflurane) in trauma patients

2019 ◽  
Vol 1 (9) ◽  
pp. 454-457
Author(s):  
Manuel Sevillano-Barbero ◽  
Claire Ruddy
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Half Life ◽  
Severe Pain ◽  
Hospital Setting ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Non Invasive ◽  
Continuous Use ◽  
The Ideal

Penthrox (methoxyflurane) is an inhaled analgesic. It is a non-invasive, lightweight, portable handheld inhaler indicated for the emergency relief of moderate-to-severe pain in conscious adult patients with trauma. It is becoming very popular in the pre-hospital setting and in the emergency department and has been proven to reduce acute pain within 6–10 inhalations. One 3 ml bottle will provide effective analgesic relief for up to 30 minutes (continuous use) or 1 hour (intermittent use). With very few drug interactions and a short half-life, it is the ideal analgesic for conscious patients. However, it is not recommended to use regularly and should not replace a good analgesic approach.

Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs

2020 ◽  
Vol 35 (3) ◽  
pp. 254-259
Author(s):  
Marc D. Trust ◽  
Morgan Schellenberg ◽  
Subarna Biswas ◽  
Kenji Inaba ◽  
Vincent Cheng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intraclass Correlation ◽  
Vital Signs ◽  
Correlation Coefficients ◽  
Trauma Team ◽  
Urban Setting ◽  
Trauma Patients ◽  
Level I ◽  
Gcs Score ◽  
Good Agreement

AbstractIntroduction:Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals.Hypothesis/Problem:The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well.Methods:Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40).Results:After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15).Conclusion:Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

scholarly journals A comparative study of designated trauma team leaders on trauma patient survival and emergency department length-of-stay

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 105-110 ◽  
Author(s):  
Garnet E. Cummings ◽  
Damon C. Mayes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Injury Severity ◽  
Patient Survival ◽  
Negative Impact ◽  
Trauma Team ◽  
Regression Modeling ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Trauma Severity

ABSTRACT Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED. Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable). Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling. Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay.

scholarly journals Using modified early warning score to predict need of lifesaving intervention in adult non-trauma patients in a tertiary state hospital

2018 ◽  
Vol 25 (3) ◽  
pp. 146-151 ◽  
Author(s):  
Leong Shian Peng ◽  
Azhana Hassan ◽  
Aida Bustam ◽  
Muhaimin Noor Azhar ◽  
Rashidi Ahmad
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Early Warning ◽  
Demographic Data ◽  
Vital Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Level Of Consciousness

Background: Modified early warning score has been validated in many uses in the emergency department. We propose that the modified early warning score performs well in predicting the need of lifesaving interventions in the emergency department, as a predictor of patients who are critically ill. Objective: The study aims to evaluate the use of modified early warning score in sorting out critically ill patients in the emergency department. Methods: The patients’ demographic data and first vital signs (blood pressure, heart rate, temperature, respiratory rate, and level of consciousness) were collected prospectively. Individual modified early warning score was calculated. The outcome was a patient received one or more lifesaving interventions toward the end of stay in emergency department. Multivariate logistic regression analysis was utilized to assess the association between modified early warning score and other potential predictors with outcome. Results: There are a total of 259 patients enrolled into the study. The optimal modified early warning score in predicting lifesaving intervention was ≥4 with a sensitivity of 95% and specificity of 81%. Modified early warning score ≥4 (odds ratio = 96.97, 95% confidence interval = 11.82–795.23, p < 0.001) was found to significantly increase the risk of receiving lifesaving intervention in the emergency department. Conclusion: Modified early warning score is found to be a good predictor for patients in need of lifesaving intervention in the emergency department.

Principles of trauma management

2018 ◽  
pp. 151-160
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Major Trauma ◽  
Trauma Team ◽  
Trauma Patients ◽  
Trauma Management ◽  
Economic Output ◽  
Specific Organ ◽  
Life Threatening ◽  
Clinically Significant ◽  
The Impact

Major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. The impact of trauma is huge. Injuries from accidental trauma worldwide causes moderate to severe disability in > 45m people each year. Trauma is the biggest killer of people age < 45y. UK annual trauma cost is ~£0.35b in immediate treatment; subsequent financial costs are unknown. UK annual lost economic output due to major trauma is ~£3.5b. Trauma management is challenging. Up to 40% of trauma patients have injuries that are initially missed, and up to 20% of these are clinically significant. The trauma team should be appropriately formed to achieve the assigned level of care and prioritize management. Guidelines for specific organ trauma management should be followed and practice standardized to ensure the best outcome.

Management of epistaxis: a guide for junior doctors

2021 ◽  
pp. 1-8
Author(s):  
Jake Ahmed ◽  
Daniel Leopard ◽  
Alex Teasdale ◽  
Wilson Cheah ◽  
Conor Marnane
Keyword(s):  
Emergency Department ◽  
Upper Airway ◽  
Junior Doctors ◽  
Initial Management ◽  
Acute Presentation ◽  
Life Threatening ◽  
A Minor ◽  
Distressing Condition

Epistaxis is commonly seen as an acute presentation to the emergency department. The level of severity can range from a minor ooze to a life-threatening bleed. The initial management is often the responsibility of junior doctors working in otolaryngology or the emergency department, so they must be familiar with the initial steps in treating this often distressing condition. The COVID-19 pandemic has complicated matters further as much of the management takes place in the upper airway. This article outlines the key considerations in the management of epistaxis, especially during the COVID-19 pandemic.

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