surviving the crash: the fourth e€¦ · surviving the crash: the fourth e well, not so much this...
TRANSCRIPT
![Page 1: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/1.jpg)
Surviving the Crash: The Fourth E
Well, not so much this one, but the next.
![Page 2: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/2.jpg)
Leading Causes of Death in Minnesota
Heart Disease 29%
Cancer 33%
Injury 9%
Stroke 9%
Chronic Lower Repiratory Disease
7%
Alzheimer's 4%
Diabetes 4%
Influenza & Pneumonia
3%
Kidney Disease 2%
Source: MDH Injury and Violence Prevention Unit
![Page 3: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/3.jpg)
Designation Levels
1 adult & ped.
Definitive care for all trauma patients
2 adult & ped.
Definitive care for most patients
3 Definitive care for some;
most major trauma stabilized and transferred
4 Major trauma stabilized
and transferred
![Page 4: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/4.jpg)
Crash Mortality
Source: Nathens, et al; JAMA 2000.
![Page 5: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/5.jpg)
![Page 6: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/6.jpg)
Tri-modal Death Distribution
Massive brain injury High spinal cord injury Major vessel disruption
Remedy: Injury prevention
1st Peak
![Page 7: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/7.jpg)
Tri-modal Death Distribution 2nd Peak
Brain injury Major chest injury Massive blood loss Ruptured spleen/liver Fractured pelvis
Remedy: Rapid recognition,
Immediate care
![Page 8: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/8.jpg)
Tri-modal Death Distribution 3rd Peak
Infection Organ failure
Remedy: Effective system of care
Performance Improvement
![Page 9: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/9.jpg)
Case Identification Chart audit, PI committee, rounds, staff report ,
patient complaint, observation
Filters fall out? Process concern?
Care concern?
Tertiary Review Provider case review
Secondary Review TPM + TMD + others?
Trauma Program Team
Tertiary Review Multidisciplinary
Process concern? Care concern?
Primary Review TPM
Develop an action plan. Define loop closure.
![Page 10: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/10.jpg)
Performance Standards
![Page 11: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/11.jpg)
05,000,000
10,000,00015,000,00020,000,00025,000,00030,000,00035,000,00040,000,00045,000,000
1938
1941
1947
1950
1953
1956
1959
1962
1965
1968
1971
1974
1977
1980
1983
1986
1989
1992
1995
1998
2001
2004
2007
Hours Flown
0
20
40
60
80
100
120
140
1938
1941
1947
1950
1953
1956
1959
1962
1965
1968
1971
1974
1977
1980
1983
1986
1989
1992
1995
1998
2001
2004
2007
Accident Rate
Source: Aircraft Owners and Pilots Association
![Page 12: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/12.jpg)
• T-bone crash • 2 vehicles
• Vehicle #1: 3 injured • Vehicle #2: Fatal
![Page 13: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/13.jpg)
• 22 year old female • Belted driver
• Estimated 40 mph
![Page 14: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/14.jpg)
Observations & Assessment
• Alert, anxious • Short of breath,
painful respirations • R side chest pain
• R lung sounds diminished
• Belly soft, diffusely tender
BLOOD PRESSURE (mm/Hg) SpO2%
142/88 96
HEART RATE RESPIRATIONS
126 20
![Page 15: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/15.jpg)
Treatments
• IVs, O2
• Collar, spine board • Code 3 to local level 4 trauma center
![Page 16: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/16.jpg)
At the local trauma center…
• Anxious • Pale, sweaty • Short of breath
• Trauma Team Activation • Warm • Blood draw • X-rays
![Page 17: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/17.jpg)
BLOOD PRESSURE (mm/Hg) SpO2%
142/88 96
HEART RATE RESPIRATIONS
126 20
BLOOD PRESSURE (mm/Hg) SpO2%
112/78 98
HEART RATE RESPIRATIONS
136 24
![Page 18: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/18.jpg)
BLOOD PRESSURE (mm/Hg) SpO2%
142/88 96
HEART RATE RESPIRATIONS
126 20
BLOOD PRESSURE (mm/Hg) SpO2%
96/68 89
HEART RATE RESPIRATIONS
142 28
BLOOD PRESSURE (mm/Hg) SpO2%
112/78 98
HEART RATE RESPIRATIONS
136 24
![Page 19: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/19.jpg)
Remedy: Rapid recognition, Immediate care
You are Here
![Page 20: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/20.jpg)
BLOOD PRESSURE (mm/Hg) SpO2%
142/88 96
HEART RATE RESPIRATIONS
126 20
BLOOD PRESSURE (mm/Hg) SpO2%
96/68 89
HEART RATE RESPIRATIONS
142 28
BLOOD PRESSURE (mm/Hg) SpO2%
112/78 98
HEART RATE RESPIRATIONS
136 24 BLOOD PRESSURE (mm/Hg) SpO2%
108/78 94
HEART RATE RESPIRATIONS
110 20
![Page 21: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/21.jpg)
• Air-lifted to level 1 trauma center
• Discharged home after 5 days
![Page 22: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/22.jpg)
Performance Improvement
Review the care
Review the crash
![Page 23: Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this one, but the next](https://reader036.vdocument.in/reader036/viewer/2022063003/5f7099b10beb614ec211ebd8/html5/thumbnails/23.jpg)
Source: National Highway Traffic Safety Administration