Presentation on theme: "A Penetrating Injury ED Thoracotomy Dr Laura Attwood"— Presentation transcript:
1A Penetrating Injury ED Thoracotomy Dr Laura Attwood EM Consultant, RVI
2Aim Statistics Case review Discuss Pre-Hospital elements Code Red Roles within the ResusDevelopment of a Traumatic Cardiac Arrest Protocol
3Statistics TARN data 3rd most common cause of trauma in North East 1st RTC2nd FallIncreasingly more common according to TARNOften Interpersonal violence related
4Statistics 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
7Background RVI Emergency Department ~ 2100 hours x 1 Consultant X 1 Regx 5 SHO’sx 2 nurses in Resus.
8Pre Hosp Info Young male Stab wound to the back ETA 5 mins Respiratory arrest but now breathing
9Team 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
10Handover30 mins on sceneDifficult to access due to Police present and perpretator still on sceneRespiratory arrest in ambulanceUnable to get IV access
11On arrival No external Catastrophic Haemorrhage A: Intubate/Ventilate Establish etCO2Monitoring attachedECG = asystoleSats = not recordablePulse check = no carotid/radial
16What next No wounds in the heart No wounds in the lung Aortic compressionWith internal cardiac compressions
17Moving 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.
18Laparotomy 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.
19Post Mortem Verbal Report Concludes above findings Grade IV Splenic lacerationWound through descending abdominal aorta
20Discussion 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
21Pre 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
22Code 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
23Lines 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
24MHP Use of Belmont and Level 1 infusers Can use with IO’s Ensure the blood is also warmed