pre-hospital stay and play versus scoop and...
TRANSCRIPT
Pre-hospital
Stay and Play
versus
Scoop and Run
Professor Mark Fitzgerald ASM
MB BS FACEM
Director of Trauma Services
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Trauma – a quaternary speciality
Injury evolution, timing of
presentation, timeliness of
intervention, time management
and coordination of resource
surgery
trauma critical care
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Victorian State Trauma System
o Prevention
o Preprogrammed response
o Reduce secondary insults
‘pre’ and ‘in’ hospital
o Rapid transfer to a Major
Trauma Service
o The ‘right patient to the right
people in the right time’
‘The Evolution of an Integrated State Trauma System in Victoria, Australia.’ Chris Atkin, Ilan Freedman, Jeffrey V. Rosenfeld, Mark Fitzgerald, Thomas Kossmann. Injury; 36(11):1277-1287,
November 2005.
3/03/2015
Large Urban population
40% penetrating trauma
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6 Time from Event
N
Airway & Ventilation compromise
Uncontrolled Haemorrhage
MOF & Sepsis
REBOA
Potentially Preventable Deaths
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7 Time from Event
N
Airway & Ventilation compromise
Uncontrolled Haemorrhage
MOF & Sepsis
Large Urban population
40% penetrating trauma
15’
REBOA
Potentially Preventable Deaths
Trauma Centre arrival
ECCN Feb 2015
8 Time from Event
N
Airway & Ventilation compromise
Uncontrolled Haemorrhage
MOF & Sepsis
Large Urban population
40% penetrating trauma
30’
REBOA
Potentially Preventable Deaths
Trauma Centre arrival
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Principal Cause of Death: Includes deaths in other units
Ranked Major Non-major Total
1 Fatal TBI 48 0 48
2 Complications of Injury 28 0 28
3 Succumbed to co-morbidities 21 2 23
4 Uncontrolled haemorrhage 5 0 5
5 Multiple Injuries 5 0 5
6 Hypoxia 3 0 3
7 DVT/PE/Fat embolism 0 0 0
8 Not coded yet 1 0 1
Total 111 2 113
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10 Time from Event
N
Airway & Ventilation compromise
Uncontrolled Haemorrhage
MOF & Sepsis
15’
Mixed Urban/Rural population
10% penetrating trauma
REBOA
Potentially Preventable Deaths
Trauma Centre arrival
ECCN Feb 2015
11 Time from Event
N
Airway & Ventilation compromise
Uncontrolled Haemorrhage
MOF & Sepsis
45’
Mixed Urban/Rural population
10% penetrating trauma
REBOA
Potentially Preventable Deaths
Trauma Centre arrival
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Pericardial tamponade and
blunt trauma
• Usually a tear in a cavity
under low pressure
• The increased availability
of U/S with prompt
diagnosis and surgery
can now lead to a
survival rate of 70-80%
‘The Definitive Management of Cardiac Rupture and Tamponade Secondary to Blunt Trauma’ M Fitzgerald, J Spencer, F Johnson, S Marasco, C Atkin, T Kossmann. Emergency Medicine Australasia (2005) 17;494-499.
Survival depends on the presence of
tamponade and the time to operative
intervention
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