trauma teams & management

7/30/2019 Trauma Teams & Management

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Trauma Teams &Trauma Teams &

ManagementManagement

or the ABC of Traumaor the ABC of Trauma

Terry JongenTerry Jongen

Clinical Nurse SpecialistClinical Nurse Specialist

Emergency DeptEmergency DeptMarch 04March 04


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What is a trauma?What is a trauma?

Any injury or wound that requiresAny injury or wound that requiresintervention to aid recoveryintervention to aid recovery Major & MinorMajor & Minor

Major ISS 16+Major ISS 16+ Minor uncomplicatedMinor uncomplicated-- single organ / limbsingle organ / limb

RPHRPH MajorsMajors 400 pa400 pa

MinorsMinors 3500 pa3500 pa


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Trauma ResponseTrauma Response

NotificationNotification St John AmbulanceSt John Ambulance-- radio / phoneradio / phone

RFDS phoneRFDS phone

Occasionally just turning up and ringing theOccasionally just turning up and ringing the

door belldoor bell


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Set UpSet Up Form a Trauma TeamForm a Trauma Team

Airway Doctor & NurseAirway Doctor & Nurse (may be nurse 3 as well)(may be nurse 3 as well)

Doctor 2 & Nurse 2Doctor 2 & Nurse 2

Doctor 3 & Nurse 3Doctor 3 & Nurse 3

Team Leader Doctor & NurseTeam Leader Doctor & Nurse

PCA (gopher)PCA (gopher)

Radiographer x2Radiographer x2


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Set UpSet Up

ResusResus Cover existing patientsCover existing patients

Airway equipmentAirway equipment

FluidsFluids

DrugsDrugs

EquipmentEquipment


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On ArrivalOn ArrivalTrauma Team CriteriaTrauma Team Criteria

HistoryHistory MechanismMechanism

MBA >30kphMBA >30kph MVA >60kphMVA >60kph Fall >3mFall >3m

PedestrianPedestrian Death in same accidentDeath in same accident EjectionEjection No Seat beltNo Seat belt

CyclistCyclist Roll overRoll over PenetratingPenetrating Ejection/extricationEjection/extrication

InjuriesInjuries

Crush injuryCrush injury 2 or more limbs broken2 or more limbs broken 2 or more body parts2 or more body parts

Spinal painSpinal pain Burns >15%Burns >15% Penetration of torsoPenetration of torso

HaemodynamicsHaemodynamics

BP


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AirwayAirway Response talking?Response talking?

Clear & open airwayClear & open airway SuctionSuction

PositionPosition

Oxygen 100% NRBOxygen 100% NRB IntubationIntubation

Surgical airwaySurgical airway Protect cervical spineProtect cervical spine


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BreathingBreathing

QuantityQuantity QualityQuality Sounds & fieldsSounds & fields

Accessory musclesAccessory muscles SupplementSupplement

BaggingBagging

Oxy logOxy log

Find any problemsFind any problems correct themcorrect them


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CirculationCirculation

Two wide bore IV cannulas 14 g or betterTwo wide bore IV cannulas 14 g or better FluidsFluids 11 litrelitre crystalloidscrystalloids

500ml colloid500ml colloid

Uncross matched bloodUncross matched blood

Collect blood (grouping & x match)Collect blood (grouping & x match)

MastMast Bandage bleedingBandage bleeding Control fracturesControl fractures


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Remember the ABC is the primaryRemember the ABC is the primaryassessmentassessment

Identifies life threats that requireIdentifies life threats that requireimmediate correctionimmediate correction


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E= ExposureE= Exposure Put the whole patient on displayPut the whole patient on display

Cut of clothing if requiredCut of clothing if required

F= FreezingF= Freezing

Keep warmKeep warm Cover and recoverCover and recover


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G= Get Vital signsG= Get Vital signs Full observationsFull observations

TPR & BP, NVO, GCSTPR & BP, NVO, GCS Bloods, BSL,Bloods, BSL, haemoquehaemoque

ECGECG

TV, Air pressure OTV, Air pressure O22 SatsSats. FiO. FiO22 Pain scorePain score

AMPLEAMPLE

?tetanus status?tetanus status Forensic evidence protectionForensic evidence protection


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H= Head to Toe assessmentH= Head to Toe assessment Systematic assessment of whole patientSystematic assessment of whole patient

Identifying other or new injuriesIdentifying other or new injuries

Log roll & PR (remember the rule)Log roll & PR (remember the rule)

Followed by a focused assessmentFollowed by a focused assessment

Commencement of treatmentsCommencement of treatments Splint fracturesSplint fractures

Dressings / suturingDressings / suturing

IDCIDC


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MeanwhileMeanwhile

Radiographers are shooting a traumaRadiographers are shooting a traumaseries of xseries of x--raysrays

Continuous reassessment of vital signsContinuous reassessment of vital signs

Calling in consultsCalling in consults

Expanded drug regimeExpanded drug regime

Gastro viewGastro view


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Other diagnosticsOther diagnostics DPLDPL CTCT

Interventional radiologyInterventional radiology


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Scary StuffScary Stuff

ThoracotomyThoracotomy Only good forOnly good for

penetrating trauma orpenetrating trauma or

controllingcontrolling abdoabdo

bleedingbleeding Cross clamp aortaCross clamp aorta

Fix holesFix holes


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More Scary StuffMore Scary Stuff

Penetrating woundsPenetrating wounds


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BurnsBurns


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Limb injuriesLimb injuries


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Interesting practicesInteresting practices

Hypotensive managementHypotensive management Some evidence that maintaining a BP 85 to 90Some evidence that maintaining a BP 85 to 90systolic has improved outcomessystolic has improved outcomes

Needs farther researchNeeds farther research Use of Clotting factorsUse of Clotting factors

Factor 7aFactor 7a

Early use of platelets & FFPEarly use of platelets & FFP


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Be awareBe aware

Shock is not just low BP and elevatedShock is not just low BP and elevatedpulsepulse

Subtle signs more importantSubtle signs more important

High index of suspicionHigh index of suspicion

Stick to the planStick to the plan


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Major Incident ResponseMajor Incident Response

West Health PlanWest Health Plan Based on MIMMS approachBased on MIMMS approach Medical Teams from the hospitalsMedical Teams from the hospitals

Single retrievalsSingle retrievals entrapmententrapment

trauma teams & management

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