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Emergency Care

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Emergency Care Dr Stephen Boyce Consultant in Emergency Medicine Sport & Exercise Medicine Specialist Registrar Definition of Trauma A serious injury or shock to the ... – PowerPoint PPT presentation

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Title: Emergency Care


1
Emergency Care
  • Dr Stephen Boyce
  • Consultant in Emergency Medicine
  • Sport Exercise Medicine Specialist Registrar

2
Definition of Trauma
  • A serious injury or shock to the body, as from
    violence or an accident.
  • An emotional wound or shock that creates
    substantial, lasting damage to the psychological
    development of a person.
  • An event or situation that causes great distress
    and disruption.

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Trauma Centre
  • Casualty
  • Accident Emergency (AE)
  • Emergency Medicine (ED)

12
Workforce Planning
  • Junior doctors
  • ENPs
  • Registrars
  • Consultants
  • Moving from a consultant led service to a
    consultant delivered service

13
What is Trauma ?
  • Major trauma describes serious and often multiple
    injuries where there is a strong possibility of
    death and disability.
  • In England, the most common cause is a road
    accident.
  • The NAO estimates that there are at least 20,000
    cases of major trauma each year in England
    resulting in 5,400 deaths and many others
    resulting in permanent disabilities requiring
    long-term care.

14
Causes of Trauma
  • Road traffic accidents (RTAs)
  • Falls
  • Burns
  • Blunt trauma
  • Penetrating trauma
  • Gunshots
  • Natural disasters, Terrorism

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Pathway of Trauma
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Trauma Scores
  • Injury Severity Score (ISS)
  • Anatomical
  • Abbreviated Injury Scale (AIS)
  • 0 - 75
  • Revised Trauma Score (RTS)
  • Physiological
  • RR, SBP, GCS
  • 0 - 12

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Trauma Deaths
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Immediate Deaths
  • First peak of deaths occurs within seconds or
    minutes of injury
  • Very few of these patients can be salvaged due to
    severity of their injuries
  • Only prevention can significantly reduce this peak

23
Early Deaths
  • Occurs within minutes to several hours after
    injury
  • Intracranial, intrabdominal, multiple fractures,
    multiple injuries, etc
  • The Golden Hour

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Late Deaths
  • Several days to weeks after the initial injury
  • Sepsis or multiple organ failure
  • The care provided during the golden hour will
    have a direct effect on long term outcome

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Advance Trauma Life Support (ATLS)
  • Originated in the USA
  • Promoted by the American College of Surgeons
    (ACS)
  • First course was January 1980
  • Gradual international recognition re trauma
    management
  • Adopted in the UK late eighties / early nineties
    RCS England
  • ATLS courses in over 42 countries

27
ATLS Concepts
  • Treat greatest threat to life first
  • Lack of a definitive diagnosis should never
    impede the application of an indicated treatment
  • A detailed history is not essential to begin the
    evaluation of an acutely injured patient

28
ATLS Objectives
  • Assess the patients condition rapidly and
    accurately
  • Resuscitate and stabilise the patient according
    to priority
  • Determine if the patients needs exceed a
    facility's capabilities
  • Arrange appropriately for the patients
    interhospital or intrahospital transfer
  • Assure that optimum care is provided

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ATLS Course
  • Lectures
  • Practical skills
  • MCQ exam
  • Moulage

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ATLS Moulage
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Assessment
  • Primary survey
  • Secondary survey
  • Transfer to definitive treatment

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Primary Survey
  • A Airway ( C-spine control)
  • B Breathing
  • C Circulation
  • D Disability (Neurological)
  • E Exposure

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Team Approach
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  • Monitoring
  • Interventions performed
  • X-rays Trauma series (C/spine lateral, chest,
    pelvis)
  • Catheters
  • Further investigations (FAST, USS, CT)
  • Blood tests

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Secondary Survey
  • Does not begin until the primary survey is
    complete, resuscitation is established
  • Complete head to toe evaluation
  • Reassessment of all vital signs
  • Further x-rays, blood tests, etc
  • Other specialty review (if not required in
    primary survey)
  • Transfer

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Triage
  • Number of casualties exceeds the available
    resources
  • A process for sorting injured people into groups
    based on their need for or likely benefit from
    immediate medical treatment
  • Essential part of major incident planning and
    preparation
  • Mobile, dynamic process
  • End point of triage is the allocation of a
    treatment priority

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Triage Categories
  • Category Description Colour Priority
  • Immediate Immediate life saving RED P1
  • treatment
  • Urgent Treatment within 6hrs YELLOW P2
  • Delayed Less serious cases GREEN P3
  • (walking wounded)
  • Expectant Non-survivable or BLUE
  • exceed resources
  • Dead Dead WHITE Dead

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Triage Sieve
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How Can We Improve Trauma Care In Scotland?
  • New STAG audit
  • Consultant delivered care (balanced against
    resources)
  • Centralisation of services (trauma centres)
  • Regular training, skill maintenance, use of
    simulators, CPD
  • Reflection MM meetings
  • Learn from others, eg, military
  • Targeted interventions

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Emergency Medicine Retrieval Service (EMRS)
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EMRS Recent Audit
  • 310 emergency retrievals
  • 1/3 trauma
  • 24 lives saved

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  • Flying doctors take to the air 25/10/2010
  • Scotland's 'flying doctor' service is to be
    rolled out to remote and rural parts of the
    country, following a successful pilot scheme in
    the west of Scotland.
  • The service, staffed by air paramedics and
    consultants who are specialists in emergency
    medicine, will fly across Scotland to treat
    critically-ill patients on the spot. Since it
    began in June 2008, the team has undertaken 565
    retrievals and given advice to a further 469
    patients.
  • The decision to expand the service was taken
    after an evaluation of the pilot programme
    concluded that it offered good quality
    healthcare, value for money in terms of benefits
    for patients and significant support for
    healthcare staff working in remote areas.

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  • Health Secretary Nicola Sturgeon said
  • Getting the best possible medical help to a
    critically-ill patient, or someone who has been
    seriously injured, as rapidly as possible can
    significantly improve their changes of making a
    full recovery.
  • "But critical illness or injury can strike
    anywhere and patients are often some distance
    from the essential medical treatment they need.
    That's where the EMRS comes in - experienced
    accident and emergency or intensive care
    consultants fly to patients in remote and rural
    communities.
  • "This early intervention can make the difference
    between life and death and that is why we have
    decided to establish Scotland's flying doctors as
    a national service, delivering first class
    healthcare to all rural parts of the country."

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Thank You
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