2. TRAUMA: The Golden Hour
MAHARASHTRA
ORTHOPAEDIC
ASSOCIATION
1 MAY---MOA DAY

4. Objectives Concept of a golden hour
Pathophysiology of shock in the trauma patient
Resuscitation according to atls principles
Overview
Specifics

5. The Golden Hour Originated by R adams cowley
First sixty minutes after the occurrence of multi-system trauma
Victim's chances of survival are greatest if they receive definitive care in the or within the first hour after a severe injury

6. The Golden Hour
Recently, the validity of the “golden hour” as a rigidly defined timeframe scrutinized
Core principle of rapid intervention in trauma cases remains universally accepted

7. Time Zero; The RTA occurs.

8. Hopefully within ten minutes the first Emergency Service personnel attend; in this case, like so many it is the Police and Ambulance.

9. If the casualty (s) are lucky it may well take only minutes for us to release them. Unfortunately it sometimes may well take over the limit of the hour.

10. To continue with this “perfect” scenario the released casualties are evacuated to hospital within the allocated sixty minutes of the hour.

12. The Golden Hour
"There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later -- but something has happened in your body that is irreparable."
- R Adams Cowley

14. The Golden Hour Time and Trauma Outcomes
no convincing studies that time to treatment consistently leads to better outcome
outcome related to many factors including reduced time between injury and definitive care
Ann Surg. 2003;237(2):153-60

16. The Golden Hour Shock Pathophysiology
inadequate organ perfusion and tissue oxygenation
3 factors determine:
1. oxygen content
2. oxygen delivery
3. distribution

17. The Golden Hour
Shock Pathophysiology
prolonged hypoperfusion creates a vicious cycle of ischemia and shock
2 most important steps in managing shock:
1. recognition
2. treatment

18. The Golden Hour Rapid Resuscitation restores circulating volume
improves oxygen delivery
prevents cellular ischemia and tissue necrosis
prevents onset of secondary cellular injury
prevents onset of MODS

19. The Golden Hour Rapid assessment Resuscitation and stabilization
What should we be doing?
Rapid assessment
Resuscitation and stabilization
Definitive management/Transfer
ATLS

20. ATLS Overview The ATLS Concept Primary Survey Adjuncts
Secondary Survey
Definitive Care/Transfer

21. ATLS Overview
Primary Survey
A Airway
B Breathing
C Circulation
D (neurologic) Disability
E Exposure / Environment
AMPLE
But this is for experts!! What can you do to help patient

22. What to do if you are first to arrive at Accident Scene
Safeguard yourself and others
Stop the other traffic and put some indicators to show that accident has happened
If there are others around, ask them to dial emergency services and police

23. What to do if you are first to arrive at Accident Scene
If there are multiple people involved in accident, there will be some who will be shouting and screaming. It means they are still breathing
Look first for someone who is silent or unconscious as they need first attention

25. What to do if you are first to arrive at Accident Scene
If the victim is unconscious, check breathing first
If they are unresponsive and breathing ensure they are in a position where they are leaning forward or to one side in a position where the airway will remain open.

26. What to do if you are first to arrive at Accident Scene
Place your hand lightly on the victim’s forehead and very gently tilt back the head. Lift up the chin with two fingers and put your cheek by the victim’s mouth to see and feel if the person is breathing. You may also want to check the victim’s chest to see if it is rising and falling. If so, then the victim is breathing

27. What to do if you are first to arrive at Accident Scene
Avoid Moving the victim unless he is obviously stuck or there is danger of fire / explosion

28. What to do if you are first to arrive at Accident Scene
If a motorcyclist is involved only remove their helmet if they are unconscious and there is no other way to assess their breathing or their airway is in danger. There is usually a way of lifting the visor, it may be sensible to loosen their chin strap

29. What to do if you are first to arrive at Accident Scene
If person is unconscious and not breathing?
Start CPR if the person is not breathing and you know how to perform it. If you do not know how to do CPR, do not attempt it. Instead, ask other bystanders if they are able or wait until emergency services arrives.
Roll the victim on to the person’s side to protect the airway. Make sure to support the person’s neck to protect or prevent injury

30. What to do if you are first to arrive at Accident Scene
If not breathing, carry out CPR
Only move onto this step if the casualty’s airway is open and clear. If they are unresponsive and not breathing, you’ll need to begin CPR immediately. Use a defibrillator if available and do not leave the casualty.
Place both hands on the casualty’s centre of the chest and give 30 chest compressions using your body weight. Perform at a rate of per minute (that’s 2 per second for 15 seconds).
Give 2 rescue breaths by tilting the casualty's head back gently while lifting their chin, pinching their nose and blowing steadily into their mouth for a second. If unable or unwilling, just give chest compressions.
Repeat – continue to give 30 chest compressions and 2 rescue breaths until help arrives.

32. We cant really train you in CPR here, but we can provide you a good you tube link to watch CPR

33. First Aid?
Keep the injured person as still as possible. Talking to a victim can go far in calming the person.
Pack clothing or bandages around the spine or broken bones to prevent movement.
Stop any bleeding by applying direct pressure to the injury with bandages or clothing.
Elevate the area bleeding to chest height if possible. If the victim is conscious, ask the person to apply pressure to help calm any shock

34. How to Aid person in SHOCK?
If you notice the most common symptom of shock— pale skin—then treat the person for it.
Remember the phrase “if the face is pale, raise the tail.” A pale face is a good indicator of shock.
Loosen any tight clothing and put blankets, coats, or clothing over the victim to keep the person warm.
If you are able, raise up the victim’s legs. Even resting the victims legs on your knees can help prevent or minimize shock. You may also want to shade the victim from the sun or falling rain to minimize shock.

35. How to Aid person in SHOCK?

36. How to Aid Bleeding person
If severely bleeding, apply pressure
Only move onto this step if the casualty is breathing normally. If they are bleeding severely, you will need to carry out the following immediately.
Apply direct pressure to the wound, ideally with gloved hands, dressing or clothing.
Secure dressing with a bandage to maintain pressure and support the injury as much as possible.

37. Comfort the Victim

38. Wait for Ambulance