Emergency

Question 1

What are examples of pre hospital services important in the treatment of trauma patients?

Answer 1

LAS - London Ambulance Services

HEMS - Helicopter Emergency services, in most critical cases

BASICS - British Association for Intermediate Care, volunteer

Good samaritan

Question 2

What are the key things to do on the scene of an accident?

Answer 2

1. Ensure personal safety - key is to be fast and thorough in short period of time
2. Rapid systematic patient assessment - idea of injuries needed to be treated
3. Treat life threatening injuries to prevent deterioration of the patient
4. Keep warm - helps with blood clotting
5. Scoop and run - monitor for deterioration and get to the nearest trauma center
6. Call ahead - to give pre-alert that trauma patient is arriving and prepare unit

Question 3

What are potential life threatening injuries that need to be treated on scene?

Answer 3

Stop external catastrophic haemorrhage

Stabilise potential injuries - neck bones can have effect on nerves

Question 4

Examples of on-site treatments that can be done on trauma patients?

Answer 4

Analgesia - drugs, splints

Make sure the patient is comfortable to prevent them from moving

Question 5

What is an estimate of the number of trauma patients in London per year?

Answer 5

20 000 cases of major trauma/year

Estimated that around 5400 deaths

Question 6

How many major trauma centers are there in London?

Answer 6

4

Network spreads across London to centralise the services

Certain trauma patients only accept patients from certain hospitals

Question 7

What are the 4 major trauma centers in London?

Answer 7

St Mary’s Hospital

King’s College Hospital

St George’s Hospital

Royal London Hospital

Question 8

What are the requirements of trauma centers?

Answer 8

24/7 consultant available on site to lead the trauma team

Trauma team should be appropriately trained and competent to deliver their role

Trauma team present 24 hours a day for immediate reception of the patient

Ability to undertake resuscitative thoracotomy in the emergency department

A massive haemorrhage protocol in place for patients with severe blood loss

24/7 immediate availability of fully staffed operating theatres

Need all the specialties within 30 minutes of the patient arriving into the hospital

Question 9

What is a resuscitative thoracotomy?

Answer 9

Open chest to have direct access of the heart

Question 10

What is involved with haemorrhage control?

Answer 10

Administration of tranexamic acid within 3 hours of injury

Transfusion specialist advice should be avaliable 24 hours a day

Blood given to patients

Question 11

What is tranexamic acid?

Answer 11

Antifibtolytic

Competitively inhibits the activation of plasminogen to plasmin

By binding to specific sites of both plasminogen and plasmin

Question 12

Which specialities may be needed by a trauma patient?

Answer 12

Neurosurgery

Spinal and spinal cord surgery

Vascular surgery

General surgery

Trauma and orthopaedic surgery

Cardiothoracic surgery

Plastic surgery

Maxiolllofacial surgery

Ear, nose and throat surgery

Anaesthetics

Interventional raiology

Intensive care

Question 13

What is a primary survey?

Answer 13

How to manage patient when they arrive at A&E

First thing to do

• Evaluates physiological parameters
• Identifies specific life-threatening conditions which can be treated in the A&E to prevent the patient from deteriorating

Question 14

What approach is used in the primary survey?

Answer 14

ABCDE approach

Structured and easy to remember

Question 15

What does the primary survey consist of?

Answer 15

A - airway

B - breathing

C - circulation and haemorrhage control

D - disability

E - entire patient and make sure didn’t miss wound

Question 16

B

Answer 16

Injuries which may affect the patient’s ability to breathe properly

Like blood or air

Tube to drain air or blood

Keep a record of patients saturation and respiratory rate

Question 17

C

Answer 17

Know pulse and BP and how they feel

Look for any signs the patient is bleeding in chest, abdomen, pelvis, bones or external wound

Not always evident where blood is from

IV fluids and blood or medications to help with clotting

Question 18

D

Answer 18

Recorded by looking at GCS

Pupils to determine brain function

Question 19

Who conducts the primary survey?

Answer 19

Different members of the trauma team conduct different parts of the survey

Question 20

What happens following the primary survey when the treatment has been instigated?

Answer 20

Review the patient and start again through primary survey

Look at patient again to see if the patient has

• changed
• improved
• deteriorated

Question 21

What can be used to obtain more information during the primary survey?

Answer 21

Fast scan - US in chest and stomach to see if there is blood

Question 22

What is the secondary survey?

Answer 22

Evaluates anatomy of the patient

More of an in depth top to toe assessment to look for any anatomical dysfunction that is not life threatening but still important

Important to look at back of the patient - may hide big anatomical injuries

Done so via log roll

Question 23

When is the secondary survey conducted?

Answer 23

Once happy with the primary survey

Question 24

What is the difference between the primary and secondary survey?

Answer 24

Secondary survey looks more at anatomical problems rather than physiological problems like primary survey

Question 25

What are examples of anatomical problems observed during secondary survey?

Answer 25

Skull fractures

Bowel perforation

Urethral injuries

Dislocations

Question 26

What are the three time periods in which trauma patients die?

Answer 26

50% of deaths happen in the first few minutes

30% of deaths happen in the first few hours

20% of deaths happen in days/weeks/months after injury

Question 27

What is the golden hour?

Answer 27

Have one hour to properly take care of patient

Clock starts at time of injury

Question 28

In which occasions are triage important ?

Answer 28

When there are multiple patients

Question 29

Who came of with the idea of trauma teams?

Answer 29

James Styner

Taught how to have structured approach to treat trauma patients