polytrauma - a team approach
DESCRIPTION
fTRANSCRIPT
MANAGEMENT OF
POLYTRAUMATISED PATIENT
A Team Approac h
“Strategies To Enhance Patient Care
Through Share Manage!ent"#
Dr Ah!a $in %& %ashi!
E!ergenc' Ph'sician
%os(ita) *ueen E)i+a,erth"
O$-ECTI.ES
• Concept of A Team Approach Patient care a) Intradepartment b) multidisciplinary
• A collaborative and coordinated effort to achievesimilar target and outcome….ATL! "TL!
INTRODUCTION
Po)'trau!a
Clinical yndrome #hereby Patient ustains
erious In$uries Involving T%o &r 'ore
'a$or &rgans And Physiological ystems.
(eaturesPhysiological Instability*+sanguinations'a$or Torso Trauma'a$or Tissue ,estruction
e.g. 'otor vehicle accident %ith ,-and spleen rupture
POLYTRAUMA
META$OLIC RESPONSE TO IN-URY
/ Catabolic counter regulatory hormones
Amplication of Catecholamine effect
* Venous shunting with preservation of vital
organs e.g. heart, brain.
* Ischaemia secondary to vasoconstriction
* Renal shutdown
Insulin /esistance
Inflammatory /esponse
Lo%ered immune resistance
*levation of free fatty acids
Altered protein metabolism
POLYTRAUMA
Meta,o)ic Res(onse To In&ur'
Cascae O0 Death 1
Deat
h
Metabolic
Acidosis
Coagulopathy
Hypothermia
TRAUMA DEAT%
Death 0ro! Trau!a 0o))o2s a
Tri!oa) Distri,ution"
3 4 Trun5e' DD 1 Sci A! 6781693:; <89: =
Conce(t An O>er>ie2 O0 Trau!a
Death 3 Tri!oa) Distri,ution
CONCEPT AND O.ER.IE?
Death 0ro! Trau!a has a Tri!oa) Distri,ution"
The First Pea5 o0 Death is 2ithin secons to
!inutes o0 in&ur'"
Causes1<" Laceration o0 the $rain6" $rain Ste!:" %igh S(ina) Cor In&ur'7" %eart@ Aorta an Large .esse)s Lacerations;" Etc"
/ Usua))' Non3Sa)>agea,)e"
?IT% RAPID ASSESSMENT AND RESUSCITATION
CARRIED OUT DURING T%E SECOND PEA @
TRAUMA DEAT% CAN $E REDUCED
Causes1
A" Su,ura) EBtraura) %ae!ato!a
$" %ae!o(neu!othoraB
C" Ru(ture s()een
D" Lacerations o0 the )i>er
E" Pe)>ic Fractures
F" Mu)ti()e In&uries Associate 2ith Signi0icant$)oo Loss"
G" Pre>enta,)e sa)>agea,)e conition
The Secon Pea5 o0 Death occurs 2ithin !inutes to a
0e2 hours a0ter in&ur' re0erre to as the
“ GOLDEN %OUR #"
The Third Pea0 of ,eath occurs several
days or %ee0s after initial in$ury
Causes1
<" Se(sis
6" Organ Fai)ure
:" DI.C
7" ARDS
;" Fat E!,o)is!
Main cause o0 e)a'e Trau!a Death is
!u)ti()e organ s'ste! 0ai)ure"
Associate co!()ications1
<" Resu)t o0 irect insu)t to s(eci0ic organ
s'ste!"
6" In re)ation to inter>entiona) (roceures"
:" In re)ation to (oor initia) resuscitation an
sta,i)i+ation e)a' in initia) in>estigation
TRAUMA DEATH
• More than :; o0 tota) SURGICAL ADMISSIONS
are TRAUMA PATIENTS"
• More than ;; o0 Death in SURGICAL
DISCIPLINE is ue to TRAUMA"
• 96 o0 Trau!a Death is ue to %EAD IN-URY"
• < o0 Trau!a Death is ue to POLYTRAUMA.
A Se>en Month Stu' 2as conucte at the E!ergenc'
De(art!ent@ %L
4-une8 3 -an8H=
• ; o0 tota) 0ata)ities occurre
2ithin 7 hours o0 a!ission
3 6n Pea5 4 Pre>enta,)e Death =
• 8 o0 these (atients ie 2ithin < hour
3 <st Pea5 4 Non Sa)>agea,)e =
* Ti!ing i not ta5e into account o0 thee)a' in Pre3%os(ita) Care Ser>ice PtTrans(ortation
Death in ED%L1 689
$ID 1 676
DID 1 ;
$ID3$rought In Dea
DID3Dea In De(art!ent Y e a
r 6 E E :
Tota) 1 ;
Trau!a 1 76
Meica) 1 <7
Death in Dept
Trau!a 1 76
%ea in&ur' 1 <:
Chest in&ur' 1 H
Pe)>ic in&ur' 1 7
Intraa,o!ina) 1 :
%ea in&ur' JOthers 1 <; 4 POLYTRAUMA =
Trauma Death
TYPE OFTYPE OFIN-URIESIN-URIES
TOTAL NO" OFTOTAL NO" OFDEAT%DEAT%
NO" OFNO" OFPR.ENTA$LEPR.ENTA$LE
DEAT%DEAT%
C%EST IN-URYC%EST IN-URY HH 66
PEL.ICPEL.ICIN-URYIN-URY
77 66
INTRAINTRAA$DOMINALA$DOMINAL
IN-URYIN-URY
:: <<
Nu!,er o0 Pre>enta,)e Death in Re)ation to
Tota) No" o0 Death
FEATURES OF POLYTRAUMA PATIENT
RE*UIRING EARLY INTER.ENTION
• Ra(i EBsanguinating
%e!orrhage
• Irre>ersi,)e S'nro!e
• O>erco!(ensate
S'ste!ic Res(onse
• Iatrogenic
Contri,uting Factors For the Incience o0
Pre>enta,)e Death 1
<" everity of In$ury
1. Poor /esuscitation 2 tabili3ation
4. ,elay in diagnosis
5. ,elayed /esponse from the relevant
/eferred ,ept
6. ,elay in decision for Intervention and
,efinitive 'anagement
7. 8o Team%or0
9. Lac0 of /esources
< Attitue o0 !eica) o00icer
6" $us'3too !an' (atients" Lack of prioritization
:" De)a' in in>estigation 0inings
eg CT scan@ US@ an ,)oo resu)ts
7" De)a' in in0or!ing s(ecia)ist 0or ecision !a5ing
;" De)a' in i!()e!entation o0 e0initi>e care MB
e"g" 3 surgica) inter>ention o0 (atient
3 Li!ite ICU ,es
%UMAN RELATED FACTOR RELATED TO
PRE.ENTA$LE DEAT%
COMPONENTS OF COMPRE%ENSI.E
TRAUMA CARE
:. Triage
1. Primary urvey
4. /esuscitation And tabili3ation
5. econdary urvey
6. /eevaluation
7. ,efinitive Care
9. /ehabilitation
TRIAGETRIAGE
A D'na!ic Process O0 Sorting Out
Patients Accoring To Their
Priorit' O0 Treat!ent
All Polytrauma Patients Are Triaged According To The
Protocol & Guidelines For Admission To The Red
Zonecritical Zone!
T-* (I/T P*/&8 T& **
T-* PATI*8T CA8 A((*CT T-*
(I8AL &;TC&'*.<<
:= survey and resuscitation of vital
functions are done
simultaneously… .. A Team
Approach
"//// F<
P&L>T/A;'A
PRIMARY SUR.EY1
,efinition
The preliminary assessment of a patient %hich is
conducted in a systematic manner %ith the ob$ective
of identifying life threatening conditions and
managing them as soon as they are found.
A&uncts to Pri!ar' Sur>e'
AD-UNCTS
?ital signs
;rinary@gastric cathetersunless contraindicated
Pulseo+imeter and C&1
Trauma X-ray•Lateral cervical•CXR•Pelvis
*C ABs
ATLS
TRAUMA TEAM
,efinition
A group of s0illful and e+periencepersonnels %or0 together at the sametime managing a polytrauma patient byrapidD efficient and effective teamEmultidiscipline).
The team include all level personnelfrom specialist to attendants.
TRAUMA TEAM CONCEPT
HOLISTIC AND QUALITY
CARE
TRAUMA TEAM
Man' stuies in e>e)o(ing countries
ha>e sho2n that K : o0 tota) hos(ita)
eath is ue to trau!a"
A 2e)) integrate trau!a s'ste! ,ase
u(on TEAM?OR an PARTNERING can
reuce the !orta)it' rate to )ess than
<"
TRAUMA TEAM
/ Match (atient nee 2ith resourceuti)isation
/ Ensure ear)' senior c)inicianin>o)>e!ent in ecision !a5ing
/ Pro>ie a coorinate a((roach toear)' trau!a care
/ Mini!i+e e)a' in the E!ergenc'e(art!ent
FEATURES OF TRAUMA TEAM
:. -ori3ontal Tas0 ,istribution
1. *rgonomics arrangements
4. Clinically 2 Therapeutically determined
arrangement of staff based upon intervention
reFuired
5. Tas0 is distributed into small manageable
pac0age unit bet%een the Trauma Team
'embers
6. 8ot Team Leader dependant
7. Goint decision ma0ing process
FEATURES OF %ORIONTAL TEAM
ORGANISATION
• All members carry out individual tas0s
simultaneously.
• 8ot focused on any particular team
member or team leader.
• *nhance Team Performance and
Improved &utcome.
• 'ost efficient organi3ation
Features o0 an e00icient tea!2or5
:. pecifically allocated to individual
members.
1. Tas0 evenly divided among Team
'embers.
4. Tas0 carried out I';LTA8*&;L>.
POLYTRAUMA CARE TEAM
• Resuscitation Trau!a Tea! H The group that resuscitated and stabili3ed
the patient
H *mergency department team %ith otherrelevance dept.
• De0initi>e care tea! H InvestigationalD interventional and intensive
care team.
P&L>T/A;'A CA/* T*A'
• The resuscitation team %ill manage thepatient rapid and systematicallystabili3ation and of need be interventional
• The definitive care team ';T response%ith immediate decision ma0ing specialist involvement
• Investigation must be automatic and resultimmediately obtainable.
P&L>T/A;'A CA/* T*A'
• Intensive care anesthesiology servicemust be available immediately .
• All interventional and surgical proceduresmust be done %ithout delay.
• All facilities reFuired eg +rayD ;D CT mustbe made available immediately toenhance care.
P&L>T/A;'A CA/* T*A'
Critical uccess (actor
• pecialist and consultant must be involved early.
• ,ecision must made immediately.
• 'anagement plan must be determined
immediately together.
• -ospital authority must enforce this policy
strictly.
• All mortality polytrauma in a $oin mortality or
census meeting
POLYTRAUMA CARE TEAM
The strength of the team is as strong its
%ea0est lin0
• Patient focus Jcommitment must be
observed…….K
STRUCTURAL LAYOUT OF
RESUSCITATION ONE
• A ,edicated (acility and 1nd 8ature /efle+
environment to enhance performance of the
Trauma Team.
• Jolf %ingK *rgonomics.
• tandardi3ation 2 'odulari3ed
/esuscitation Bay
RESUSCITATION $AY FLOOR PLAN
AIRWAY EQUIPMENT'&8IT&/I8
>T*' ,/;
P/&C*,;/*
T/&LL*>
T*A' L*A,*/
,&CT&/ 4
8;/* 4
,&CT&/ :
8;/* :
,&CT&/ 1
8;/* 1
GOLF S?ING ERGONOMIC COCPIT ARRANGEMENTGOLF S?ING ERGONOMIC COCPIT ARRANGEMENT
SECOND NATURE REPONSESECOND NATURE REPONSE
RESUSCITATION $AY
CeillingMounted
LTRA S!"# $AC%L%T%&S
Trauma Team should be managed as
smoothly and as efficiently as a
PIT T&P
in a
(&/';LA &8* /AC*
Al'ays %n (Pole Position)
(Ready To Roll)
Su!!ar' o0 Po)'trau!a Tea!
Functions
• Accurate C)inica) -ug!ent
• E00ecti>e Resuscitation Sta,i)i+ation
• Accurate Ra(i Decision Ma5ing
• A((ro(riate Ra(i De0initi>e CareInter>ention
• Co))ecti>e Co))a,orati>e ecision!a5ing ,ase u(on Patientsconition
CONCLUSIONS:. mooth 2 efficient management of trauma victim.
1. Preserve the principles of Trauma Team despite varying
resourcesD manpo%er 2 infrastructure.
4. Change of attitude to%ards Trauma Care 2 Inculcate spirit
of team%or0..
6. ;pgrade 0no%ledge 2 s0ill in 'odern Concept of
Trauma Care.
7. Importance of integrated Trauma ystem.
9. /educe morbidity and mortality.
*L&A#&RSH%P+
(Leadership is li,ting a persons visionto higher sights the raising o, personper,ormance to higher standard the
building o, a person)s personalitybeyond its normal limitations)
Peter #ruc.er
T%AN YOU