CASE #1. Crash em up... 18 yo belted male, MVC on 2 lane, rollover 2 a.m., car is all smashed up... -Awake, GCS 15, HR=125, RR 14, BP 80/60 –”I can’t.

Slides:

Advertisements

Similar presentations

Stroke Workshop Case Scenario.

Advertisements

NEXUS Who needs spinal motion restriction and xrays? (Optional Module)

EMT 052 – Winter 2004 Assessment Review Scene Size-Up  Determine the # of Patients  Call for additional help if necessary  Can my unit handle this.

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.

Evidence in the ED: “Pain in the Neck” Clearing the C-Collar Yolanda Michetti Dept of EM University of Pennsylvania.

Principles of Trauma Symphony of Surgery

Head Injury Saurabh Sinha Department of Clinical Neurosciences Western General Hospital.

NICE HEAD INJURY GUIDELINES WHAT ARE THE GUIDELINES FOR THEIR INITIAL ASSESSMENT IN ED – All patients with a head injury should be assessed by an.

Mallika Khwanmuang Phatcharapol Udomluck Jitsupa Litleangdej th year medical students.

Mild Closed Head Injury Presentation of guidelines about adult closed head injury in A&E Medical meeting 20/06/2012 Dr David.

TRAUMA. PATIENT DATA N.H 53/M Married Filipino Roman Catholic Pasig city.

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.

© 2005 by National Safety Council Serious Injuries Lesson 6.

OSCE - Questions PMH Jan Case 1 F/38, history of Schizophrenia Drank a bottle (60ml) of Red Flower Oil Repeated vomiting, denied any tinnitus GCS.

Trauma Triage Criteria Inservice 1998 Composed by: Laurie A. Romig, MD, FACEP Bayflite/Bayfront Medical Center.

TRANSITION SERIES Topics for the Advanced EMT CHAPTER Assessment of the Trauma Patient 15.

ASSESSMENT AND MANAGEMENT OF THE TRAUMA PATIENT Instructor Name: Title: Unit:

Case Presentation: BLS to ALS Handoff 21 year old male Unrestrained driver, single vehicle MVC 20mph; sedan vs. concrete barrier No airbag Starred windshield.

Head injury audit Dr Ivo Dukic, Senior House Officer in Emergency Medicine Ms Caroline Plant, Staff Nurse in Emergency Medicine Dr Feroz Rahim, Staff.

Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Isolated Loss of Consciousness in Head Trauma Lee LK, Monroe D, Bachman MC, et al;

Clearing the C-Spine David Ouellette TALK TRAUMA 2011.

DOCUMENTATION. OUTLINE  Overview value of excellent documentation  Define, discuss, review SOAP notes  Review how it should look in MEMSRR  Questions.

CASE STUDY MVA TRAUMA. Code 3 Trauma Team Activation December 12, 2006, around 11 a.m. MVA rollover with three teenage females involved. The teens were.

Copyright © 2004, Mosby Inc. All rights reserved..

Spinal Trauma. Anatomy and Physiology  Vertebral Column  Spinal Cord.

Focused History and Physical Examination of the

Submitted by:Thomas Morgan MS4 Faculty reviewer:Sandra Oldham M.D. Date accepted:30, August 2007 Radiological Category:Principal Modality (1): Principal.

Abdominal Trauma Begashaw M (MD).

Clinical Hx (Case 1) 22 year old male. Ejected from a vehicle during a high speed single vehicle rollover. Immediate complaints of chest and back pain.

Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.

First Aid for Colleges and Universities 10 Edition Chapter 13 © 2012 Pearson Education, Inc. Head and Spine Injuries Slide Presentation prepared by Randall.

Approach to Trauma Patients Joseph Turner, MD Indiana University School of Medicine.

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

SPM 200 Skills Lab 8 Basic Trauma Life Support and Trauma Resuscitation Daryl P. Lofaso, M.Ed, RRT Clinical Skills Lab Coordinator.

CASE SIMULATION Debriefing. Diagnosis? Altered level of consciousness Respiratory insufficiency Acute subdural hematoma Possible inflicted traumatic brain.

BLS ALS TRANSPORT In Whatcom County. Do you need help? 78 y.o. female, GLF, hip pain Patient is lying on her side on the bathroom floor. Gasping Pale.

CLAVICULAR FRACTURES…. DANGEROUS??? Kristin Ratnayake, MD Pediatric Emergency Medicine Fellow October 3, 2013.

Patient Assessment And Management 1 By Ethan Bjorklund Dave Furey Grant Riedemann.

Case presentation Intern 黃毓琦. Personal profile  Name : 簡 X 涵  Gender : female  Age : 49 years old  Chart number :  Arrival date.

Patient History  TO  14 year old male  Lives in Palau  Right-handed  Informant: Patient, good reliability Chief Complaint: Wrist Injury.

Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old 24% 77% 52%

EXTREMITY TRAUMA Instructor Name: Title: Unit:. OVERVIEW Relationship of extremity trauma to assessment of life-threatening injury Types of extremity.

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.

Paediatric Trauma August 2013 update. Background Injuries from motor vehicle crashes are the leading cause of mortality in children aged 5 years and older.

TRAUMA ASSESSMENT. PRIMARY SURVEY AIRWAY – Assess for patency/obstruction Chin lift/ jaw thrust Clear FB’s Oropharyngeal airway Intubation/surgical airway.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 24 Abdominal and Pelvic Trauma.

VCU DEATH AND COMPLICATIONS CONFERENCE. Introduction of Case  Complication Death  Procedure  Ex. Lap, Splenectomy, Left anterior thoracotomy, Ligation.

ED trauma meeting 26 th July 2012 C spine Bonanza.

Emergency Medical Response You Are the Emergency Medical Responder You arrive at the scene of a motor-vehicle collision, a fender bender, in which a woman.

PAEDIATRIC TRAUMA. Learning outcomes Approach to patient Approach to patient Differences compared to adult trauma Differences compared to adult trauma.

Survey the Scene --mechanism of injury --nature of illness.

Injuries to the Abdomen, Pelvis, and Genitalia Injuries to the Abdomen, Pelvis, and Genitalia.

Minor head injury. What is it? Head injury GCS >12 Adults (16-65): LOC, amnesia, confusion Kids ??

CRANIOCEREBRAL TRAUMA. Etiology/Pathophysiology HEAD INJURY Causes death or serious disability. Second most commom cause of neurological injuries. Major.

First Aid/CPR Chapter 13 Notes Injuries to the Head, Neck, and Back.

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

Emergency Department Aberdeen Royal Infirmary Head Injuries in the Emergency Department August 2015.

Spinal Assessment When to Immobilize and When Not to Immobilize.

SFGH Cervical Spine Clearance Protocol

Minimal Traumatic brain Injury in children

Sports Injuries T. Bray B. Bray.

25 yo healthy male college student

Chapter 9 Common surgical problems Trauma

HEAD CT DECISION RULES – WHO TO SCAN?

Pulmonary Pathology November 27, 2017

Should C-Spines Be Cleared in the Prehospital Setting?

Acute Spinal Cord Injury

Geriatric Trauma updated Nov 2017

Chapter 9 Common surgical problems Stabilisation of Trauma

Presentation transcript:

CASE #1

Crash em up yo belted male, MVC on 2 lane, rollover 2 a.m., car is all smashed up... -Awake, GCS 15, HR=125, RR 14, BP 80/60 –”I can’t move my arms and legs….” -Head atraumatic - Neck, chest/abd ok - Extremities atraumatic -Neuro exam – what do you want to know?

Crash em up yo belted male, MVC on 2 lane, rollover 2 a.m., car is all smashed up... -Awake, GCS 15, HR=125, RR 14, BP 80/60 –”I can’t move my arms and legs….” -Neuro exam – no motor function to lower or upper extremities, no sensory function below neck.

Smash em up... Arrive at Trauma Center: 3 liter IVF (1 prehospital, 2 in ED) HR 125, BP 85/60 Still can’t move arms/legs…

Where’s the blood? Chest… Abdomen… Pelvis… Thigh… Spine… Head... CXR U/S FAST, CT Pelvis XR Thigh Exam Spine XR/CT, exam Head exam, CT

Cervical Alignment l Anterior vertebral body l Posterior vertebral body l Spinolaminal line l Spinous process tips

Compression/Burst fracture

Where’s the blood? Chest… Abdomen… Pelvis… Thigh… Spine… Head... CXR Normal U/S: fluid! Pelvis XR Normal Thigh exam ok Abnormal neuro/XR! Norml exam

Manage Blood in the Abdomen: Fluid, Blood, OR Manage Neuro Shock: Pressors (dopamine)

If he’s still hypotensive: OR! If BP normalizes: CT! 3 liters IVF…. BP 95/60, HR 110…

Where’s the blood? Chest… Abdomen… Pelvis… Thigh… Spine… Head... CXR Normal U/S: fluid! CT++ Pelvis XR Normal Thigh exam ok Abnormal neuro/XR Norml exam

Crash em up yo belted male, MVC on 2 lane, rollover 2 a.m., car is all smashed up... -Awake, GCS 15, HR=125, RR 14, BP 80/60 –”I can’t move my arms and legs….” -Neuro exam – no motor function to lower or upper extremities, no sensory function below neck. Goes to the OR – remove the spleen. Stabilizes….. Neurosurg next – stabilize spine Discharge to a tough road ahead….

CASE #2

56 yo male -EMS Response for altered level of consciousness -Chief complaint: alcohol detox & suicidality…. Drinks every day, homeless…found in the gutter….. Negative review of systems Transported to Emergency Department and Emergency Psychiatry for medical clearance to detox Meds: NoneNKDA Pmhx: Negative Exam: intoxicated, no signs of trauma, GCS=15 Intoxicated, sobers up in the ED overnight

56 yo male -EMS Response for altered level of consciousness -Chief complaint: alcohol detox & suicidality…. Transported to Emergency Department and Emergency Psychiatry for medical clearance Intoxicated, sobers up in the ED overnight 8 a.m.: Psychiatrist consult to me…. “Trying to decide whether he should have a head CT, he’s been falling down a lot lately….”

Crocodile Hunter: The Early Years... Future Career? When do we do a Head CT?

The Canadian CT Head Rule for Pts with Minor Head Injury The Lancet 2001;357: l New Orleans’ CT rule published in 2000 New England Journal Medicine. l 3121 Canadians to 10 large Canadian hospitals.

Lancet 01;357: Minor head inj = witnessed LOC, definite amnesia, or witnessed disorientation

Basilar Skull FX Clinical Diagnosis -Racoon’s Eyes -Hemotympanum -Battle Signs (Rhino/Otorrhea)

New Orlean’s/Charity Criteria 7 components: Headache, Vomiting, age>60, drug or Etoh Intox, memory impairment, trauma above the clavicles, seizure. (No GCS, No Mechanism) Haydel: NEJM 2000;343:100-5

Developing a decision instrument to guide CT imaging of blunt head injury pts J Trauma 2005;59: l 21 hospitals. l 13,728 Patients l 917 Injuries on CT (6.7%)

Recursive partitioning: 8 Criteria l Evidence of Skull Fracture l Scalp Hematoma l Neurologic Deficit l Altered Level of Alertness l Abnormal Behavior l Coagulopathy l Persistent Vomiting l Age > 65 Years Mower: J Trauma 2005;59: Unique to this study

Burton’s Rules: Vomiting, age>60, memory impairment, basilar skull or open/depressed, seizure, GCS 60, memory impairment, basilar skull or open/depressed, seizure, GCS <15 +/?Loss of Consciousness and nothing else = No CT

Solution: Wear a Helmet

56 yo male -EMS Response for altered level of consciousness -Chief complaint: alcohol detox & suicidality…. Transported to Emergency Department and Emergency Psychiatry for medical clearance Intoxicated, sobers up in the ED overnight 8 a.m.: Psychiatrist consult to me…. “Trying to decide whether he should have a head CT, he’s been falling down a lot lately….”

Burton’s Rules for Head CT: Vomiting, age>60, memory impairment, basilar skull or open/depressed, seizure, GCS 60, memory impairment, basilar skull or open/depressed, seizure, GCS <15, anything abnormal and a history of alcoholism +/?LOC and nothing else = No CT

CASE #3

54 year old male Right Hip Injury History: Water Skiing – one ski, right leg Abduction injury PMHx: None Drugs: NoneAllergies: None Exam: GCS=15, pulse ox = 96%; HR=115, BP =145/78 Right hip and knee flexed – pain to right hip. Right hip and knee flexed – pain to right hip. No other injury

54 year old male Right Hip Injury History: Water Skiing – one ski, right leg Abduction injury - EMS - Fentanyl –multiple doses - In the ED - MSO4 – 20 mg over multiple doses -XR: Fracture/Dislocation R hip. - “Native” hip dislocation

“Native” Hip Dislocation 1) Every hour that passes = 10% increase in ischemic necrosis of femoral head – not to be confused with PROSTHETIC Hip Dislocation 2) Many will not have a fracture – only dislocation 3) Reduction in hip = reduction in pain! 4) Check for neurologic/vascular deficit 5)Immobilize and get moving! (to a trauma center)

54 year old male Right Hip Injury History: Water Skiing – one ski, right leg Abduction injury - In the ED Propofol for sedation… very heavy sedation, multiple doses - Failed reduction attempts - Reduced in the OR! “Native” hip dislocation

CASE #7

Fell off the ladder… 65 yom “workin on the roof….fell off the ladder onto my left chest…broke my ribs!” - Hurts when he takes a deep breath. No back/neck pain. No abdominal pain. - Exam: Vitals signs normal. No increased respiratory effort. Normal breath sounds - Tender along left ribs – 9-10 … Nontender abdomen…

Left Chest Ribs: Fractured/Contusion Lung: Pneumothorax Lung Contusion Diaphragm: Ruptured Diaphragm Spleen: Contusion/Fracture Kidney: Contusion/Fracture Large Bowel: Rupture/Contusion

Fell off the ladder… 65 yom “workin on the roof….fell off the ladder onto my left chest…broke my ribs!” - Hurts when he takes a deep breath. No back/neck pain. No abdominal pain. Fractured spleen: observed til hospital day 3 – discharged to followup.

CASE #8