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Trauma Case Presentation
Dr Martyn Rees Shrewsbury & Telford Hospital NHS Trust
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RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car
Time Events T minus 14 min (16.18hrs) RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car Air travel 7 metres, thrown into garden Age 11yrs Medical Emergency Response Incident team
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RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car
Time Events T minus 14 min (16.18hrs) RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car Air travel 7 metres, thrown into garden Age 11yrs At scene Cardiac arrest on Ambulance arrival Blood around face, head wounds Fractured femur CPR in progress I-gel & IO Needle Medical Emergency Response Incident team
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RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car
Time Events T minus 14 min (16.18hrs) RTA 700 yards from Royal Shrewsbury ED Cyclist hit by car Air travel 7 metres, thrown into garden Age 11yrs At scene Cardiac arrest on Ambulance arrival Blood around face, head wounds, # femur CPR in progress I-gel IO Needle in humeral head 2222 Call “Cardiac Arrest, Child” = Paediatric Arrest Team group call Medical Emergency Response Incident team
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MERIT Team arrival with child CPR ongoing
Time Events T + 0 16.32hrs MERIT Team arrival with child CPR ongoing Trauma Team ED Consultant & Team Anaesthetic Consultant & SpR Surgical Registrar Paediatric APNP (Consultant en-route) ODP x3 PEA arrest Intubated size 6.0 ETT, OG tube MILS throughout Medical Emergency Response Incident team
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Time Events T + 3min Adrenaline IO 1000mls 0.9% saline bolus T + 5min
No air entry left chest → ICD insertion T + 7min Medical Emergency Response Incident team
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BS 3mmol/L → 60mls 10% glucose IV
Time Events T + 3min Adrenaline IO 1000mls 0.9% saline bolus T + 5min No air entry left chest → ICD insertion T + 7min T + 8min ROSC BS 3mmol/L → 60mls 10% glucose IV T +14min Pelvic splint & binder, right & left lower limb splints T + 16min 2nd IO needle humeral head 1st unit O negative blood Major Haemorrhage Protocol active Medical Emergency Response Incident team
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CPR, tranexamic acid 500mgs & adrenaline IO
Time Events T +19min Weak carotid T + 20min No pulse CPR, tranexamic acid 500mgs & adrenaline IO T + 24min ROSC but pupils fixed & dilated T + 26min 2nd unit O negative blood Narrow-complex tachycardia BP 84/53 T + 28min MERIT Team FAST scan: free fluid in abdomen T + 30min 1000mls 0.9% saline left IO T + 33min 1000mls 0.9% saline right IO T + 34 min Transferred to theatres, led by MERIT Focussed Assessment Sonograph for Trauma
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Time Events T+ 34min Pre-op assessment IPPV with paralysis, ↓ movement left chest but CXR no PTX, ICD in-situ BP un-recordable & tachycardia Pupils fixed & dilated Surgery 700mls blood in abdomen, liver lacerations KIDS → BCH Surgical Advice: pack and close Left Femur & Pelvic fractures, urinary catheter no blood pH 6.9 Lactate 12 CVL & IA line Blood & clotting products Adrenaline & insulin infusions (BS 25mmol/L)
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Surgery T+30min T+90min T+150min
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Time Events T + 2hr & 40min 45 minutes of relative CVS stability Mean Art Pressure 70mmHg HR /min 2hr & 50min KIDS, Trauma Desk & Local Team Joint Decision Time Critical Transfer to BCH Escort: SaTH Anaesthetist & ODP En-route Telephone support from BCH Hypotension Tx 2 units blood Unstable on arrival
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MERIT KIDS Child Ambulance Local Trauma
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