Trauma sensitisation for Paramedics in strife torn places like Kashmir

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TRAUMA MANAGEMENT ROLE OF HEALTH CARE PROVIDERS

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SPEAKER Dr SUHAIL YAQOOB TRAUMA SURGEON MBBS,MS, FNB (TRAUMA CARE) ATLS INSTRUCTOR

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1” – 4” Decade deaths Loss of productive years Handicaps -Vehicular Road traffic Deaths per day in India(estimate)270. Violence related Disasters Thermal Chemical

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Vehicular / RTA / MVA Road traffic Deaths per day in India(estimate) 270. According to official statistics 80,118 persons were killed and 342,200 persons injured in road traffic crashes in India in 2000. Accidental deaths and suicides in India 2000. 1-178. 2002. New Delhi. National Crime Records Bureau, Ministry of Home Affairs.

WAR ZONES : 

WAR ZONES

TRIMODAL PATTERN OF DEATHS Immediate 50% , Early 30%, Late 20% Immediate : within few minutes Lethal injury – Brainstem, Cardiovascular, upper sp. Cord . little can be done. Prevention the best option : 

TRIMODAL PATTERN OF DEATHS Immediate 50% , Early 30%, Late 20% Immediate : within few minutes Lethal injury – Brainstem, Cardiovascular, upper sp. Cord . little can be done. Prevention the best option

Nebraska Conception & inception : 

Tragedy in 1976 changed the face of trauma care An orthopedic surgeon ,piloting his own plane, crashed in rural Nebraska cornfield His wife died instantly, the surgeon sustained serious injuries, 3 of his children had critical injuries Nebraska Conception & inception

Nebraska Conception & inception : 

The surgeon recognizing how inadequate his treatment was , stated “When I can provide better care in the field with limited resources than what my children and I received at the primary care facility – there is something wrong with the system and the system has to be changed.” “Indeed the system has been changed” BUT NOT FOR US YET Nebraska Conception & inception

The Concept of ATLS : 

Three important concepts: Most important was to treat the greatest threat to life first Lack of a definitive diagnosis should never impede the application of an indicated treatment Detailed history was not essential prerequisite to begin the evaluation of an acutely injured The Concept of ATLS

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ABCDE approach to evaluate & treat the injured

Initiate definitive treatment. Notify the receiving facility and Provide rapid transport : 

Initiate definitive treatment. Notify the receiving facility and Provide rapid transport To Prevent Early Deaths Golden hour (s) Prevent further injury,

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The pre-hospital/hospital assessment and management of a trauma patient should be performed under the direction of one person.

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Take body substance isolation precautions.

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Universal precautions such as Face Masks, Eye Protection, Water Impervious apron, Gloves & leggings.

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Ensure scene safety, scene survey, mechanism of injury and number of patients.

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Establish patient responsiveness . A Open the airway: a. Chin lift b. Use the jaw thrust if spinal trauma is suspected. Establish and maintain a patent airway while protecting the cervical spine. Suction as necessary. Insert an oropharyngeal or nasopharyngeal airway adjunct

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B Evaluate breathing Is the patient breathing spontaneously? Are respirations adequate in rate and depth? Environmental factors should be considered when removing the patient’s clothing for evaluation

Look for: 1. nasal flaring 2. cyanosis 3. rapid respiration(tachypnea) 4. open wounds or bruising of chest wall : 

Listen for: 1. breathing 2. abnormal breath sounds 3. stridor – indicates partial airway obstruction 4. gurgling sounds Look for: 1. nasal flaring 2. cyanosis 3. rapid respiration(tachypnea) 4. open wounds or bruising of chest wall

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Assist ventilations High flow, 100% concentration oxygen using non-rebreather mask

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C circulation and perfusion a. Check for the presence of a pulse. b. Check blood pressure. c. End organ perfusion.

IV fluids large bore 2 Crystalloids Control hemorrhage with direct pressure or a pressure dressing.Pelvic binding : 

supine position with feet higher than head IV fluids large bore 2 Crystalloids Control hemorrhage with direct pressure or a pressure dressing.Pelvic binding

WHAT WILL YOU DO FIRST ? : 

WHAT WILL YOU DO FIRST ?

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The Trauma Slogan is “First save a life and then save a limb”

DDisabilityHEAD AND SPINE TRAUMAHaving excluded lack of oxygen and low blood pressure as the cause, consider trauma to brain secondary injury hypoxia and shock support of the patient’s ABC’s : 

Oxygenate and IV Fluids DDisabilityHEAD AND SPINE TRAUMAHaving excluded lack of oxygen and low blood pressure as the cause, consider trauma to brain secondary injury hypoxia and shock support of the patient’s ABC’s

ABC IS TAKEN CARE OF IN HEAD Tx : 

ABC IS TAKEN CARE OF IN HEAD Tx

ANY COMMENTS ? : 

ANY COMMENTS ?

ARE WE RESPONSIBLE ? : 

ARE WE RESPONSIBLE ?

Rigid cervical collar and immobilize the patient : 

Rigid cervical collar and immobilize the patient

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E Environment & maintain the patient’s Body temperature Warm blankets Warm Intravenous fluids

NECESSARY INVESTIGATIONS : 

NECESSARY INVESTIGATIONS

A wound in the chest may be an open chest wound : 

Cover with a sterile occlusive dressing taped on three sides A wound in the chest may be an open chest wound

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Any organs protruding from abdominal wounds should not be replaced. Amputated parts should be wrapped in sterile gauze moistened with normal saline and put in ice water. Do not allow the amputated part to freeze.

CAN IT BE SALVAGED ? : 

CAN IT BE SALVAGED ?

YES REPLANTED : 

YES REPLANTED

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EXTRA CARE PATIENTS Elderly : Altered physiology Children : Altered physiology and anatomy with psychological factors Pregnant : Two lives

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BURNS Burns have extent and depth. In case of burns pour room temperature tap water on the burnt part for 5-10 minutes and cover it with a clean sheet of cloth. All rings, watches, jewelry, and belts are removed, tourniquet-like effect. Apply a dry sheet and prevent hypothermia. Inhalation injury (e.g. stridor, muffled voice, singed facial/nasal hairs, If the injury involves an electrical burn, initiate cardiac monitoring. Start two large bore IVs. Insert a Foley catheter. Pain relief: Morphine. Oxygen as required. Give all medications intravenously. Glucose may be necessary in a child. Rapid, uncontrolled transport of a burn victim is not a priority

Pre – Hospital Care (EMS system)(Airport, Earthquake, Railways, expressways,juvenile & drunk driving, weak laws) EMS Staff ( Properly Trained )CommunicationTriageTransportation : 

Pre – Hospital Care (EMS system)(Airport, Earthquake, Railways, expressways,juvenile & drunk driving, weak laws) EMS Staff ( Properly Trained )CommunicationTriageTransportation

: 

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TRIAGE To sort and prioritize. Greatest good for greatest no.

Rapid transferGround transport vs. air retrieval : 

Rapid transferGround transport vs. air retrieval

PATHETIC AND RISKY : 

PATHETIC AND RISKY

HOSPITAL CARE A&E deptt, OT, Acute care units > Communication – site, Police HQ, > Prepared, alert team > Team leader > Horizontal Approach > Predesignated Team > Pre-assigned Job > Crowd Control > Universal Precaution > Documentation Records > Public Information > Media > VIP : 

HOSPITAL CARE A&E deptt, OT, Acute care units > Communication – site, Police HQ, > Prepared, alert team > Team leader > Horizontal Approach > Predesignated Team > Pre-assigned Job > Crowd Control > Universal Precaution > Documentation Records > Public Information > Media > VIP

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Crowd Control Media VIP

ANXIOUS CROWD & RELATIVES : 

ANXIOUS CROWD & RELATIVES

MULTIORGAN Tx : 

MULTIORGAN Tx

Summary : 

Trauma remains the leading cause of death in first four decades of life Loss of life in early years is most tragic Nebraska Tragedy in 1976 changed the face of trauma care – ATLS The life threatening injury kills & maims in certain reproducible time frames Time is vital – “GOLDEN HOUR” Use the useful mnemonic “ABCDE” approach to its full Pre-hospital agencies and the hospital administration have to work in close cooperation to achieve the best Try assuming the role of emergency medical technicians Upgrade ambulance service & monitoring in it Summary

Remember the golden hour has already begun in the pre hospital period. No brownian motion, no chaos, no confusion. Work in tandem : 

Remember the golden hour has already begun in the pre hospital period. No brownian motion, no chaos, no confusion. Work in tandem “To sing a chorus everyone should know the song”

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Prevention Education, legislation, seat belts, infant seats, air bags, substance abuse Worldwide peace Above all prayers to prevent natural disasters Insha Allah Hope the Health Administration tries to Establish a NonExistent Trauma care Management in our trouble Torn valley

THANK YOU : 

THANK YOU