Initial Evaluation and Treatment of the Multiple Trauma Victim
A Structured Trauma Team Approach to the Initial Management of Trauma.
-
Upload
angelina-wilcox -
Category
Documents
-
view
236 -
download
2
Transcript of A Structured Trauma Team Approach to the Initial Management of Trauma.
A Structured Trauma Team Approach to the Initial Management of Trauma
Aims of Session
• Discuss a Structured Trauma Team Approach
• Practice a Structured Trauma Team Approach
• Familiarisation with clinical simulation
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Outline
• Establish setting• Bat phone call• Discuss preparation in pause & discuss fashion• Bring in patient & commence scenario• Consider trying different ambo handover methods or
different 1* survey approaches to emphasise points• Practice team update if necessary to emphasise benefits
of team communication• Finish by debriefing with video playback
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
The Setting
• Metropolitan / Regional Hospital
• Facilities: – General surgery / orthopaedics / anaesthesia / ICU /
24hr OT all available– Neurosurgery / cardiothoracic surgery / interventional
angiography not available
• Investigations available– X-Rays, FAST, CT, pathology – 24hrs
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Bat Phone Call
– I: 20 yr old male. – M: High speed MBA rider vs car– I: Unconscious– Hypotensive initially – responded to fluid– S: HR 90, RR 10, SBP 70 ↑ 90 after fluid– GCS 3, BSL 10, SaO2 92%RA– T: Intubated, Collar, 1000mls Hartmanns
– A: Unknown– M: Unknown– B: Unknown– O: Arriving in 10 minutes
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Discussion Points
• Benefits of effective preparation• Benefits of IMIST whiteboard• Trauma Call• How do you organise the team?• How do you identify team members? • Do you establish an initial team plan?• Where should you do the Ambulance handover? • Who should do the Primary Survey?
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Team Approach
• Rapid Primary Survey talking out loud
• Simultaneous assessment & resuscitation
• Summarise & confirm findings at end of 1* Survey
• Team Leader coordinates management decisions
• Communicate, communicate, communicate…
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Team Updates & Decisions
• Summarise & confirm initial findings as a team in an ABCDE fashion…..– Team Leader talk to team– Confirm findings & get feedback & suggestions– LIMITS mnemonic checklist
• Clinical decision making as a team– Team Leader outlines management plan & gets feedback– Team Leader articulates final plan
• Re-evaluate ABCDEs regularly as a team – Throughout the resuscitation and particularly if patient condition
changes or after interventions
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Organise Your Team…..
– I: 20 yr old male. – M: High speed MBA rider vs car– I: Unconscious– Hypotensive initially – responded to fluid– S: HR 90, RR 10, SBP 70 ↑ 90 after fluid– GCS 3, BSL 10, SaO2 92%RA– T: Intubated, Collar, 1000mls Hartmanns
– A: Unknown– M: Unknown– B: Unknown– O: Arriving in 10 minutes
Plan A?
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Debriefing Questions
• What happened?
• How did you feel?
• How did the team function?
• What did you learn?
• What would you change?
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Summary of Case
• High speed MBA
• Pre-hospital hypotension from splenic injury
• Pulmonary contusion & closed head injury
• Deterioration secondary splenic rupture
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010
Key Points – Structured Approach
• IMIST Pre-notification on whiteboard• Preparation
– Roles– Identification– Initial patient specific plan - mental model
• Ambo Handover - on trolley unless moribund• Primary Survey by TL or delegate• Parallel ABCDE assessment & resuscitation• Summarise 1* findings & plan Mx as a team• Continually re-evaluate ABCDEs as a team• Early decision making if tertiary transfer required• Communicate, communicate, communicate…...
These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010