Introduction to Trauma PDF

EHS201 Introduction to Trauma Introduction to Trauma 8/23/2023 INTRODUCTION TO TRAUMA 1 Lesson Objectives By the end of this lesson, you will be able to: Discuss international trends in accident mortality; Discuss the most common i...

EHS201 Introduction to Trauma Introduction to Trauma 8/23/2023 INTRODUCTION TO TRAUMA 1 Lesson Objectives By the end of this lesson, you will be able to: Discuss international trends in accident mortality; Discuss the most common injuries in the UAE; Explain the approach to managing the trauma patient; Discuss the “golden principles” and special considerations in trauma care. 8/23/2023 INTRODUCTION TO TRAUMA 2 Trauma in Abu Dhabi 2nd leading cause of death behind cardiovascular disease 8/23/2023 INTRODUCTION TO TRAUMA 3 Trauma in Abu Dhabi Road-traffic incidents resulted in 67% of fatalities in Abu Dhabi 8/23/2023 INTRODUCTION TO TRAUMA 4 World Health Organization More than 1.25 million people die each year as a result of road traffic collisions. Road traffic injuries are the leading cause of death among people aged between 15 and 29 years. Nearly half of those dying on the world’s roads are “vulnerable road users”: pedestrians, cyclists, and motorcyclists. Road traffic crashes cost most countries 3% of their gross domestic product. Without sustained action, road traffic crashes are predicted to become the seventh leading cause of death by 2030. 8/23/2023 INTRODUCTION TO TRAUMA 5 Fatal Road Traffic Injuries Drivers were the most affected Seat-belt use may have been a factor 8/23/2023 INTRODUCTION TO TRAUMA 6 Who is at risk? Socioeconomic Status o More than 90% of road traffic deaths occur in low- middle-income countries o Road traffic death rates highest in Africa Age o People aged 15 to 44 years of age account for 48% of global road traffic deaths Sex o 73% of all road traffic deaths involve young males under the age of 25 8/23/2023 INTRODUCTION TO TRAUMA 7 Road Deaths by Age Teenagers, young adults, and older adults most at risk 8/23/2023 INTRODUCTION TO TRAUMA 8 Leading Causes of Death in Children Road-traffic injuries lead to most childhood fatalities 8/23/2023 INTRODUCTION TO TRAUMA 9 Risk Factors in Road Traffic Collisions Speeding Driving Under the Influence (DUI) Nonuse of motorcycle helmets, seatbelts, and child restraints Distracted Driving Unsafe Road Infrastructure Unsafe Vehicles 8/23/2023 INTRODUCTION TO TRAUMA 10 Life Years Lost 43,000 health life years lost in 2011 8/23/2023 INTRODUCTION TO TRAUMA 11 Cost 1.3 million first aid cases 130,000 ER visits 12,000 hospitilizations 514 fatalities 8/23/2023 INTRODUCTION TO TRAUMA 12 Real Cost 8/23/2023 INTRODUCTION TO TRAUMA 13 Trauma Care 8/23/2023 INTRODUCTION TO TRAUMA 14 Trauma Care Trauma care should be based on research Interventions are based on the assessment of each trauma patient Deliver the trauma patient: o with the appropriate interventions; o to the right facility; o utilizing the right mode of transport; o in the right amount of time; o as safely as possible. 8/23/2023 INTRODUCTION TO TRAUMA 15 Research Research provides us with the foundation for the best practices for trauma care. o Validates our current practices o Refutes our current practices o Determines future practices 8/23/2023 INTRODUCTION TO TRAUMA 16 Team Approach A diverse team must work together in order to provide trauma patients with the best chance for a favorable outcome. o Citizens o Dispatch o EMS o Transport Services o Emergency Department o Surgery o Specialty Services o Rehabilitation 8/23/2023 INTRODUCTION TO TRAUMA 17 What to do? Principles is a fundamental scientific or evidence-based tenet for patient improvement or survival Preference is how the healthcare provider achieves the principle o The preference depends on: Situation that exists Condition of the patient Knowledge and skills of the healthcare provider Protocols Resources available 8/23/2023 INTRODUCTION TO TRAUMA 18 Patient Assessment Begins with dispatch information o Chief Complaint o Location Scene and Situation o Safety o Available Resources o Number of Patients Determine Mechanism of Injury (Kinematics) Patient Assessment o Primary Survey (XABCDE) o Secondary Assessment o Reassessment 8/23/2023 INTRODUCTION TO TRAUMA 19 Time-Critical Patients Transport o Ground versus air o Mode of transport Time-critical versus non-time-critical o Appropriate destination 8/23/2023 INTRODUCTION TO TRAUMA 20 Time-Critical Patients Airway occlusion or difficulty in maintaining a Uncontrolled external hemorrhage patent airway Suspected internal hemorrhage Abnormal respiratory rate Signs and symptoms of shock Inadequate tidal volume Significant external blood loss Hypoxia GCS less than 14 Respiratory distress Altered mental status Suspected skull fracture Seizure activity Flail chest Sensory or motor deficit Suspected pneumothorax, hemothorax, Penetrating trauma to head, neck, anterior or tension pneumothorax posterior chest or abdomen, and above the Pelvic fracture elbow or knee Two or more proximal long-bone fractures Amputation Crushed or mangled extremity Trauma with significant medical history Multisystem trauma Open or depressed skull fracture Suspected brain injury Paralysis 8/23/2023 INTRODUCTION TO TRAUMA 21 Errors in Trauma Care Not establishing a safe scene Overlooking life threats by not adequately assessing or exposing the patient Focusing on distracting, non-life-threatening injuries Performing a secondary assessment prior to stabilizing all life threats Not starting with “the basics” Prolonged scene time Overlooking signs of deterioration in a patient who initially appeared noncritical Failure to reassess Transport or destination decision error 8/23/2023 INTRODUCTION TO TRAUMA 22 Golden Principles 8/23/2023 INTRODUCTION TO TRAUMA 23 Golden Principles Ensure the safety of prehospital care providers and the patient Assess the scene situation to determine the need for additional resources Recognize the kinematics that produced the injuries Use the primary survey to identify life-threatening conditions The best chances of survival from trauma occur when interventions take place as quickly as possible 8/23/2023 INTRODUCTION TO TRAUMA 24 Golden Principles Provide appropriate airway management while maintaining cervical spine stabilization as indicated Support ventilation and deliver oxygen to maintain an SpO2 greater than 95% Control any significant external hemorrhage Provide basic shock therapy, including appropriately splinting musculoskeletal injuries and restoring and maintaining normal body temperature 8/23/2023 INTRODUCTION TO TRAUMA 25 Golden Principles Maintain manual spinal stabilization until the patient is fully immobilized For critically injured trauma patients, initiate transport to the closest appropriate facility as soon as possible after EMS arrival on scene The goal is for EMS to limit scene time to 10 minutes with severely injury patients Initiate warmed intravenous fluid replacement enroute to the receiving facility 8/23/2023 INTRODUCTION TO TRAUMA 26 Golden Principles Obtain the patient’s medical history and perform a secondary assessment when life-threatening problems have been managed or ruled out Provide adequate pain relief Provide thorough and accurate communication regarding the patient and the circumstances of the injury to the receiving facility Above all, do no further harm 8/23/2023 INTRODUCTION TO TRAUMA 27 8/23/2023 INTRODUCTION TO TRAUMA 28 References American College of Surgeons Committee on Trauma (2020). Prehospital Trauma Life Support, Ninth Edition. Jones & Bartlett Learning. Andrew Pollak (2018). Nancy Caroline’s Emergency Care in the Streets, Eighth Edition. Jones & Bartlett Learning. 8/23/2023 INTRODUCTION TO TRAUMA 29