Trauma in the Emergency Department Dr Pramod Chandru

Trauma in the Emergency Department Dr Pramod Chandru

Case • Prehospital alert (BAT call) • 60 year old male • M: Car vs Tree at 100 km/hr, patient was driver of vehicle • I: Left sided chest pain and left hip pain • S: HR 150, BP 100/40, RR 29, Sa. O 2 100% on 15 L NRBM , GCS 14 (E 3, V 5, M 6) • T: 1 x 20 G in L cubital fossa “difficult IV access on scene”, 2 x 20 mg Ketamine IV for pain relief, pelvic binder and C spine collar in situ

Discussion • What are the issues? • • Correct and clear labelling How will you prepare • Staff • Space • Stuff

Case • On arrival to the Emergency Department • Primary Survey: • A: patent and protect, no orofacial injury • C spine: Collar in sitar • B: Decreased air entry to left side, subcutaneous emphysema and asymmetrical chest rise • C: HR 140 in sinus tachycardia, SB 100/40, Cool peripherally • D: GCS 14, temperature 35. 0

Discussion • Crisis Resource Management Principles: • What are the key issues here • What are the team goals • What are the priorities and next steps • How would you communicate this?

Case

Case • A Venous Blood Gas was performed: • p. H 7. 1 • p. CO 2 30 • Pa. O 2 35 • HCO 3 10 • Lactate 7 • Hb 150

Discussion • Crisis Resource Management Principles: • What are the key issues here • What are the team goals • What are the priorities and next steps • How would you communicate this?

Hemorrhagic shock in trauma • Stabilise • Stop the bleeding • Resuscitatie • Definitive Management