The Harmony Factor.

Slides:

Advertisements

Similar presentations

Interesting Case Rounds

Advertisements

Neck of Femur Fractures

Pelvic Fractures 2 nd Northern Trauma Network Conference P Fearon Consultant Orthopaedic Trauma Surgeon - RVI.

Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96% Next move: A) advance ET tube B) needle thoracostomy.

Saving Lives By Strengthening Our Region’s Trauma Care System December 5, 2013 MICHAEL SLOAN, MD CASE STUDIES IN ABDOMINAL TRAUMA.

Principles of Trauma Symphony of Surgery

SAQ 1 Monash Health Practise Exam A 25 year old female pedestrian is brought in to your tertiary emergency department by ambulance having been.

Case 1 CR2 莊景勛 2007/08/28. Patient’s Profile Name: 林 X 琪 Gender: female Age: 14 years old Chart number: Arrival time: 2007/07/1, 16:42.

Author Dr. Chan Chun Man Oct., 2013

Trauma Associated Severe Hemorrhage (TASH)-Score: Probability of Mass Transfusion as Surrogate for Life Threatening Hemorrhage after Multiple Trauma The.

Transfusion Management of massive haemorrhage in children Ongoing severe bleeding (overt / covert) and received 20ml/kg of red cells or 40ml/kg of any.

The Trauma Evaluation Kenneth DeSart, MD

Paper Reading Int. 林泰祺.

Broward General Medical Center Level I Trauma Center

Definition of Massive Transfusion Replacement of a blood volume equivalent within 24hr Transfusion>10 unit within 24 hr Transfusion > 4 units in 1 hr.

Advanced Trauma Life Support An Introduction to management of the trauma patient Rob Simpson Acute Block Teaching.

Management of pelvic fractures: the first 24 hours. Peter Worlock Newcastle General Hospital.

Trauma Registry Inclusion Criteria. Montana Trauma Registry Inclusion Flow Chart.

Senior clinician Request: a o 4 units RBC o 2 units FFP Consider: a o 1 adult therapeutic dose platelets o tranexamic acid in trauma patients Include:

Chapter 9 Common surgical problems Trauma. Case study: Hamid 14 year old boy was involved in the accident with a car.

Case Studies Shelley Atkinson, MSN, ANP-BC, ACNP-BC

Caitlyn. 4 Year old girl Climbing on steel gates at 1015 hr 2 gates ~100 kg fell on her trapped - gates removed by her father brief loss of consciousness.

Transfusion Management of Massive Haemorrhage in Adults Patient bleeding / collapses Ongoing severe bleeding eg: 150 mls/min and Clinical shock Administer.

Death Audit Mr Rasika Champia 40/ Male. Dr Smarajit Patnaik Consultant Orthopaedic Apollo Hospitals, Bhubaneswar.

A Patients Survival Story Dr Laura Attwood EM Consultant, RVI Pre Hospital Care Consultant, GNAAS.

VCU DEATH AND COMPLICATIONS CONFERENCE Sihong SuyApril 5, 2012.

Case 1 Farwaniya hospital. 36 y/o Male. Previously healthy. Brought to casualty by ambulance after being hit by a car.

Case Report 95/06/11 Intern 張偉德. Patient ’ s Profile  Name ：郭 ○ 玲  Age ： 40 y/o  Sex ： female  Chart no. ：  95/6/25, 12:04 入 ER.

MORTALITY REVIEW: CRITICAL INCIDENTS Dr Tengku Abdul Kadir Tengku Zainal Abidin Supervised by: Dr Khairuddin Ismail.

ED trauma meeting 26 th July 2012 C spine Bonanza.

 Obstetric Emergency  Follow Vaginal or C/S  Best definition - Diagnosed Clinically Excessive Bleeding makes patient symptomatic Other def- EBL > 500.

INTEGRATED PERIOPERATIVE CARE: MAJOR NON-CERVICAL SPINE PATHWAY OHSU Anesthesiology & Perioperative Medicine Grand Rounds November 30 th, 2015.

Objectives  To understand the structured approach to circulation problems  To recognise and manage shock.

Abdo / Pelvis Trauma. Learning Objectives At the end of this session, participants will be able to: Describe the initial evaluation and management of.

James Regan Trauma M&M. Situation Admitting Dx: MVC Procedure: Resuscitative thoracotomy, exploratory laparotomy Complication: Death.

Trauma M Pearson. What is current? Low volume resus Intravascular fluids Tranexamic acid use Damage control surgery Modified RSI Mx bleeding and coagulopathy.

Trauma and Cardiac Resuscitation Dr. Paul Pageau Staff Physician Assistant Fellowship Director EMUS Department of Emergency Medicine University of Ottawa.

Doubly bad. Prehospital Monday 4 th April :23 high speed head-on MVA at Birkdale 2 patients Flail chest, severe abdo pain & pelvic # ?compound.

Monash Health SAQ Exam SAQ 15 & 21.

Approach to trauma patient

Critical Care Outreach

Trauma case Stephen Lo.

PENETRATING TRAUMA.

“Running with the Bulls” Massive Transfusion in the ED

Chapter 9 Common surgical problems Trauma

Management of the Trauma Patient

Francis Connon Royal Melbourne Hospital

TRAUMA Resuscitation A quick review

Critical Concepts - Surgery

( Lecture ) Trauma in Urology.

Management of Pelvic Trauma in ED

Initial Assessment of Trauma Patient

Trauma Case Presentation

Pelvic vascular injuries

Cracked Ribs and Sucking Holes

Introduction to Trauma

E.C Monday, February 27th Donna Ferguson, M.D.

TRAUMA ACTIVATION TIMELINE

Neuro-critical Transfers

Cardiac case base discussion

Major Haemorrhage Management

Why Harmony was bumped…

Motocross is stupid.

Neuro-critical Transfers

Chapter 9 Common surgical problems Stabilisation of Trauma

A CASE OF NEGLECTED PELVIS FRACTURE

Presentation transcript:

The Harmony Factor

Prehospital Saturday 12th February 17:48 Glamorgan Vale M: Motorcycle v car at 80km/h I: LOC, severe groin, L thigh & R leg pain 300mL blood loss PV S: HR 110, SBP 98/74, Sats 98% RA, GCS 15 T: methoxyflurane, morphine 15mg, ketamine 80mg Donway splint application 1200mL crystalloid

Arrival 19:20 AIRWAY & BREATHING CIRCULATION DISABILITY Airway patent & protected RR 20, Sats 100% NRB CIRCULATION HR 99, BP 85/43, cool peripherally FAST negative Active bleeding from vagina DISABILITY GCS 15, Temp 36.8

CXR

Pelvis Xray

First venous gas

Initial ED management CIRCULATION 3 units packed cells vagina packed Medical notes Medication chart Fluid chart INCOMPLETE DOCUMENTATION CIRCULATION 3 units packed cells vagina packed Pelvic binder removed ABs??? ADT??? Ketamine sedation??? Analgesia???

2ndary Survey Urogenital injury Long bone injuries Anterior labial laceration through clitoris no bleeding in vaginal vault Unable to identify urethra For EUA Long bone injuries

R leg XR

L wrist XR

CT scan 20:00 Open book pelvic # 12 rib # 4.5cm diastasis of pubis R SIJ diastasis Suggestion of blush R pudenal artery 12 rib #

Problem List/Injuries Compound pelvis # Vaginal laceration Urethral injury Active haemorrhage Blush on CTA R tib/fib # L radius #

Further ED management Gynaecology r/v → EUA Urology r/v → EUA & catheter placement Orthopaedic r/v → EUA & washout Surgical r/v → EUA (sigmoidoscopy)

Further ED management Interventional Radiology review given CT findings and ongoing instability IR suite – 00:00 no pelvic bleeding to account for PV loss Placed SPC

Disposition Stayed in ED awaiting EUA To OT 07:58 ED stay 12 hr 38 min

Pre-op ABG

Transferred to OT with a single pink cannula Thoughts? Transferred to OT with a single pink cannula

Progress Intra-operatively Post operatively Pre-op resuscitation & insertion of lines Maintained C-spine precautions Continued to bleed → Massive Transfusion 7 units PRBC, 9 FFP, platelets Haemostasis with 3 stitches in anterior labial wound Post operatively PE ORIF pelvis

Issues raised…. ED Documentation – need to have more senior doctors documenting Should the binder have come off?? Awaiting IR for open book C-spine clearance prior to OT Under-resuscitated prior to OT, Single cannula, ‘forgotten patient’

Issues raised…. System Junior doctors galore – no decision makers Multiple doctors identified bleeding from vulva (O & G, ortho, gen surg) yet no –one sutured it