objectives 1) pre-hospital trauma care – regional trauma systems and triage 2) hospital...

Objectives

1) Pre-hospital trauma care – Regional trauma systems and

triage

2) Hospital care

3) Post-hospital follow-up care1Nelson Elias, Brasil

Where am I now? Why?

Espírito Santo - BrasilSouth-Eastern Region

Territorial area – 46.000.000 km2Population – 3.500.000

More than 400km of sunny coast Natural Resources - oil, natural gasAgriculture - banana,bean,cocoa

coffee, cornSteel IndustryTwo harbors

2Nelson Elias, Brasil

Nelson Elias, Brasil 3

Tubarão Harbor Vitória Harbor

The Hospital

Private HospitalCity: Vila Velha – population ≅ 500.000

3,5 km from Vitória (capital- Metropolitan area)

Easy access! Near the most important highway (Sun highway)


Sun highway – Rodovia do sol

Vila Velha – Guarapari (beaches – touristic region)

Extension 67 km


1) Pre-hospital trauma care Regional trauma systems and triage

-SAMU – Urgency Mobile Assistance Service – Brazilian Health Ministry-Phone 192 – 24 hours service –ambulances -Transfer patients for orthopedic center reference after previous contact (our hospital is reference)



Motorcycle in severe casesFaster

Only during the day (not at night and when raining) – to avoid accidents



Helicopter rescue (special conditions) by fire department


2) Hospital care Elderly patient

- Multidisciplinary team (on-call hip fracture support team)

- Surgical priority- Majority – Operated within 48 hours

- Early mobilization (rehabilitation program)

- Geriatric evaluation - falls prevention - Osteoporosis investigation, treatment

and prevention of others fractures 9Nelson Elias, Brasil

2) Hospital Care Trauma patient

- Evaluation – trauma room

- Stable yes - ETC

if not - DCO (external fixation)


2) Hospital Care Adult patient

- After pre-operative evaluation the patients are operated as soon as possible

- If delay, more than 48 hours, the diaphyseal fractures of femur and tibia are fixed , temporary, with external

fixation


2) Hospital Care Pediatric patient - They are evaluated by a pediatric

and orthopedic surgeon

- Operated within 24 hours of trauma


2) Hospital care – Orthopedic department- Ten orthopedic surgeries / day

- Twelve orthopedic surgeons

- Eight orthopedic residents

- Trauma protocol

- Friday morning –clinical session


2) Hospital Care Rehabilitation

- All operated patients are referred to physiotherapy program as soon as possible

- Post operative treatment: the patients are evaluated and normally discharged on day 2 or 3 after surgery


3) Post-Hospital follow-up care- All patients, after discharge of hospital, are oriented to return to out patient department, according to the fracture -The patients without conditions to stay at home are transferred to chronic care hospital

-There is a special program for geriatric patients –Home care -The patients are monitored by phone calls of social service and by hospital infection commission


2) Hospital care – Orthopedic department- Residence in orthopaedic (Brazilian Society of Orthopedics)- Sub specialty program in spine and trauma- Sub specialties: - Arthroscopic - Articular reconstruction - Upper limb - Lower limb - Trauma - Hand and Microsurgery - Spine - Pediatric - Orthogeriatric


2) Hospital care- General hospital / 200 beds – All specialists

- Local research ethics committee

- ICU for 16 patients

- Emergency Department / CT scans / MRI

- Surgical center-10 operating rooms - 02 C arms

- Trauma room


Why ?


objectives 1) pre-hospital trauma care – regional trauma systems and triage 2) hospital...

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