Presentation on theme: "A Penetrating Injury ED Thoracotomy Dr Laura Attwood"— Presentation transcript:
1 A Penetrating Injury ED Thoracotomy Dr Laura Attwood EM Consultant, RVI
2 Aim Statistics Case review Discuss Pre-Hospital elements Code Red Roles within the ResusDevelopment of a Traumatic Cardiac Arrest Protocol
3 Statistics TARN data 3rd most common cause of trauma in North East 1st RTC2nd FallIncreasingly more common according to TARNOften Interpersonal violence related
4 Statistics Home Office In 2009-10 In 2012/13 North East rate for violent crime = 3rd highest in all regions of England & Wales at 560 incidents per 1000 persons1st = London, 2nd = East MidlandsIn 2012/135th highest725 offences
7 Background RVI Emergency Department ~ 2100 hours x 1 Consultant X 1 Regx 5 SHO’sx 2 nurses in Resus.
8 Pre Hosp Info Young male Stab wound to the back ETA 5 mins Respiratory arrest but now breathing
9 Team preparation Trauma Team call ED Staff Cardiothoracic surgeon contacted and set off for hospitalOrange on call contacted ICU consultantThoracotomy kit moved next to bedTeam briefed on potential for Thoracotomy
10 Handover30 mins on sceneDifficult to access due to Police present and perpretator still on sceneRespiratory arrest in ambulanceUnable to get IV access
11 On arrival No external Catastrophic Haemorrhage A: Intubate/Ventilate Establish etCO2Monitoring attachedECG = asystoleSats = not recordablePulse check = no carotid/radial
12 On arrivalX1 posterior chest stab wound= Thoracotomy Initiated
13 Thoracotomy KitVSUnable to use surgical kit as not enough nursing staff availabel to deal with opening and handing kit etc…
16 What next No wounds in the heart No wounds in the lung Aortic compressionWith internal cardiac compressions
17 Moving on Unable to obtain large IV access IO line establish in tibiaBlood pushed through with 20ml syringeConsultant General Surgeon arrives and extends the damage control trauma surgery to Laparotomy.
18 Laparotomy Evidence of splenic disruption ?gone through descending abdominal aorta alsoAbdomen packed to control haemorrhageUnable to regain output from patientDecision taken as a team to stop resuscitation and patient pronounced dead.
19 Post Mortem Verbal Report Concludes above findings Grade IV Splenic lacerationWound through descending abdominal aorta
20 Discussion Points Pre Hospital – stay and play vs scoop and run Code Red callVenous AccessHow to get the MHP into the patientStaffingDevelopment of a Traumatic Cardiac Arrest Protocol
21 Pre Hospital Paramedics involved Training and Education issues Do the land paramedic crews understand what we want to do to the patients when they arrive and why it is so time critical?? Scoop and Play
22 Code red call Who is alerted: Would this have helped? Blood transfusion for MHP to be activatedPorters to collect MHP form labTrauma TheatreTrauma Team PersonnelWould this have helped??More staffing – possible resource from ODP/Theatre Staff
23 Lines Trauma Subclavian Line/Peripheral Access = ideal If we can’t…. Just lean towards IO’sx2 yellow IO’s in humeral heads with Level1 attachedSignificant success in Military Operations
24 MHP Use of Belmont and Level 1 infusers Can use with IO’s Ensure the blood is also warmed