WELCOME AND OPENING (ANTERO FERNANDES / DANIEL DE BACKER)
Reminder of all the terrorist attacks this year and last – Paris, Brussels
Improvement of trauma care has never been more important
PRE-HOSPITAL MANAGEMENT OF SEVERE TRAUMA (ANTERO FERNANDES / DANIEL DE BACKER)
The epidemiology of trauma (Sebastian Kuhn)
Accidents happen anywhere, anytime and can affect everyone
WHO Global Health Estimates 2014 – http://www.who.int/gho/mortality_burden_disease/mortality_adult/en/
Trauma = cancer + heart disease + HIV
Prevention e.g. education and Design e.g. airbags have reduced deaths on the road
Trauma registry – information about status quo and help to improve efficiency and quality of care
Trauma registry e.g. EuroTARN (http://eurotarn.man.ac.uk/)
- Function
- system for performance improvement
- quality control queries
- monitor trauma system trends
- supply benchmarking data
- Reports:
- Comprehensive quality report once a year
- up-to-date quality report online
- Content:
- Descriptive data
- Comparative report on hospital mortality/outcome data
How to improve
- Structural guideline
- Treatment guideline
- Trauma network
- Trauma registry
The essence of pre-hospital trauma care (Luis Meira)
Trimodal to bimodal distribution of death in trauma (Golden hour to platinum ten)
Not everything can be done pre-hospital
What is essence of trauma?
- Management of the scene?
- Management of airway and ventilation?
- Management of circulation?
“It is the art of managing priorities”
Traumatic cardiac arrest: Unsurvivable? (Anne Weaver)
Clearly it is survivable.
Common cause of traumatic cardiac arrest (pic)
- unsalvageable haemorrhage
- hypoxia
- hypovolaemia
- cardiac tamponade
- tension pneumothorax
- medical
BUT outcomes poor: 0-3% survival (depending on criteria)
Who survives? http://www.annemergmed.com/article/S0196-0644(06)00412-4/pdf
TRAUMATIC CARDIAC ARREST; ERC GUIDELINES 2015 heftemcast.co.uk/traumatic-card…
Resuscitative thorocotomy – http://emedicine.medscape.com/article/82584-overview
Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) – http://lifeinthefastlane.com/ccc/resuscitative-endovascular-balloon-occlusion-aorta-reboa/
Securing the airway and anaesthetising the unstable trauma patient (Martin Dünser)
The indications for securing the airway in trauma pt are numerous but haemodynamic instability (potential) underlies all of them.
RSI in theatre vs trauma (v different priorities)
Process of key (pic)
Shock values – http://anesthesiology.pubs.asahq.org/data/Journals/JASA/931191/0000542-200409000-00002.pdf?resultClick=1
Dunser – KETAMINE, KETAMINE, KETAMINE
3 tips peri-intubation
- Arterial line
- Pre-emptive use of vasopressor
- Start with moderate minute volume
MANAGING SEVERE TRAUMA IN THE ED (ANTÓNIO MARQUES / Daniel De Backer)
The role of sonography (Daniel De Backer)
Sonography and CT complement each other
Leading causes of haemorrhage chock – spleen/liver, retroperitoneal, haemothorax, multiple fractures, wounds
Role of ultrasound in trauma
- detection of free abdo fluid
- detection of haemothorax/pneumothorax
- detection of cardiac tamponade
US faster than CT and detects significant alterations BUT solid organ lesions and retroperitoneal bleeding may be missed.
FAST scan in trauma – http://www.sonoguide.com/FAST.html
CT-scan: When and for whom? (Marc Leone)
Vittel criteria for severe trauma triage: Characteristics of over-triage
Incidental findings on whole-body trauma computed tomography: Experience at a major trauma centre
Who needs damage control resuscitation? (Jacques Duranteau)
Only interventions to control haemorrhage and focus on re-establishing survival physiological status
The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition ccforum.biomedcentral.com/articles/10.11…
Give transexamic acid (1gm) within 3 hours of injury
Early shock resuscitation: Fluids and/or vasopressors (Dirk Donker)
Trauma pts have the potential to have all 4 forms of shock – hypovolaemic, distributive, cardiogenic and obstructive.
Utility of the shock index in predicting mortality in traumatically injured patients